Through childhood and adolescence, our bones increase in strength and density. Bone mass reaches its maximum density at around 25 years of age and then drops off slowly. Adverse lifestyle habits such as smoking, excessive drinking or an unhealthy diet can influence peak bone mass. A low peak bone mass puts individuals at greater risk of osteoporosis in later life, even with the normal rates of bone loss. As the bone mineral content falls, the fragility of the bones increases, and so does the risk of fractures.

Osteoporotic fractures are generally diagnosed by the use of x-rays. However, a painless bone density test is much more effective as it allows osteoporosis to be detected before fractures occur, and treatment can commence without delay. These tests are widely available at virtually all major hospitals and medical centres.

The factors that increase your likelihood of developing osteoporosis are:

• Gender – you are more likely to develop osteoporosis if you are female
• Being post-menopausal – the loss of oestrogen after menopause is a major risk factor
• A family history of osteoporosis – inherited factors account for a major part of an individual's disease risk 
  
• Limited physical activity and inadequate dietary calcium intake
• Limited exposure to sunlight resulting in low vitamin D intake
• Cigarette smoking and excessive alcohol intake
• Prolonged use of certain medications such as high dose cortisone
• Some diseases, including hyperparathyroidism and intestinal malabsorption

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There are treatments that help patients cope with fracture pain, as well as those that increase and maintain bone density, and those that supply the missing key elements involved in bone strength.

They include:

• Hormone replacement therapy (HT), which largely prevents bone loss in postmenopausal women and can reduce fracture risk 
  
• Bisphosphonates, which prevent bone loss and rebuild lost bone mass
• Selective oestrogen receptor modulators (SERMs), which help  increase bone density and therefore reduce fracture risk
  
• Strontium ranelate, which reduces fracture risk but the mechanisms of action are not well understood
  
• Vitamin D supplements, which are particularly important for individuals who are unable to get enough vitamin D from sunlight

The best strategy for osteoporosis is prevention; a balanced diet rich in calcium and vitamin D, and regular exercise that includes weight-bearing exersise (eg. running, skipping, weights) at least three times a week, can help. It is also useful to have regular bone density tests after the age of 60.

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Garvan’s bone and mineral research combines clinical, molecular, and cellular research to explore the links between genetic, hormonal and lifestyle influences on the achievement of optimum bone mass.

In our molecular research, scientists have discovered that the brain hormones leptin and neuropeptide Y have different effects on bone formation, which could lead to the identification of new treatments for osteoporosis. Our research has also uncovered two gene variants that put post-menopausal women at an increased risk of having a hip fracture.

More recently, other genetic markers that indicate low risk of osteoporotic fractures have been identified. Markers such as these provide a starting point for genetic testing for osteoporosis, and most importantly suggest novel targets for potential therapies.

The research draws on the Dubbo Osteoporosis Epidemiology Study (DOES), which is the world’s longest running large-scale epidemiological study of osteoporotic fractures in men and women. This study, which began in1989, involves over 3500 participants in the NSW regional centre of Dubbo and aims to identify the lifestyle factors that contribute to improvement or deterioration of our bones. In addition to this population study, Garvan is also conducting a genetic study with over 400 members of large extended families, in order to pinpoint the genes important to bone health.

Results from DOES recently identified that, contrary to popular belief, osteoporosis is not just a woman’s disease. While women are initially twice as likely as men to have a first fracture, the risk of a man’s second fracture substantially increases to the point where it is the same as in women.

Garvan scientists are now developing a screening model for doctors to identify, at an early stage, people who have a high risk of fracture. These patients are the ones who could most benefit from preventative therapies. The screening model includes simple tests of postural ability that, in conjunction with bone mineral density measurements, could be used to better predict fracture risk.

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