Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone typically as a result of hormonal changes, or deficiency of calcium or vitamin D. Osteoporosis occurs when the creation of new bone doesn't keep up with the removal of old bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure. As bones become less dense, they weaken and are more likely to break. It affects men and women of all races. But white and Asian women — especially older women who are post menopausal — are at highest risk. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. So when you will be like 50 or more and have broken a bone, ask your physician or healthcare provider about a bone density test.

"According to a report of International Osteoporosis Foundation (IOF), there are at least 3.80 lac people have been suffering Osteoporosis in Bangladesh and at least one in five men and one women in three suffer a fracture due to osteoporosis in their remaining lifetimes."

It is estimated that 200 million people have osteoporosis worldwide. Osteoporosis becomes more common with age.  About 15% of White people in their 50s and 70% of those over 80 are affected.  It is more common in women than in men.  In the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected.  Rates of disease in the developing world are unclear.

There are 8.9 million fractures worldwide per year due to osteoporosis. Globally, 1 in 3 women and 1 in 5 men over the age of 50 will have an osteoporotic fracture. Data from the United States shows a decrease in osteoporosis within the general population and in white women, from 18% in 1994 to 10% in 2006. White and Asian people are at greater risk.

People of African descent are at a decreased risk of fractures due to osteoporosis, although they have the highest risk of death following an osteoporotic fracture.

In 2014 in the World Osteoporosis Day which falls on October 20 President of Diabetic Association of Bangladesh Prof A K Azad Khan said, "Osteoporosis is called the silent epidemic because of its symptomless development and the lack of public awareness,"

Why is it so serious?
Breaking a bone is a serious complication in old age as a result of osteoporosis. Although osteoporotic bone breaks are most likely to occur in the hip, spine or wrist, but other bones can break too. In addition to causing permanent pain, osteoporosis causes some patients to lose height. When osteoporosis affects vertebrae, or the bones of the spine, it often leads to a convex or deformed posture. Osteoporosis may limit mobility, which often leads to feelings of isolation or depression. Additionally, twenty percent of seniors who break a hip die within one year from either complications related to the broken bone itself or the surgery to repair it. Many patients require long-term nursing home care.

Causes of Osteoporosis:
There are several health problems and some medical procedures that increase the risk of osteoporosis. Those causes are Autoimmune disorders (i.e. Rheumatoid Arthritis, Multiple Sclerosis etc), GIT disorders (i.e. Inflammatory Bowel Disease, Weight loss surgery etc), Endocrine/Hormonal Disorders (i.e. Diabetes, Hyperpara-thyroidism, Hyperthyroidism, Irregular periods, Premature menopause, Low level of testosterone and estrogen hormone etc), Medical Procedures (i.e. Gastrectomy, Gastrointestinal Bypass Surgery etc) and other medical diseases (i.e. AIDS, COPD, Liver Disease, Organ Transplant, Stroke, Leukemia, Different types of cancer etc) etc.

Not only are these but also there are some medicines that are responsible for osteoporosis. If you have those medicines for long-term or over dose you may suffer from osteoporosis in future. So people should be aware during using those types of medicines.
We can classify those medicines who are responsible for osteoporosis is, Aluminum-containing antacids, Antiseizure medicines (only some) such as Dilantin or Phenobarbital, Some Chemotherapy drugs like Cyclosporine A, Methotrexate and FK506 (Tacrolimus), Heparin, Proton Pump Inhibitors (PPIs), Steroids (Glucocorticoids) such as cortisone and prednisone.

Note: These causes are not only responsible for osteoporosis. There are also so many causes too.

Prevention: What should we do for prevention?
Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones. Lifestyle prevention of osteoporosis is in many aspects the inverse of the potentially modifiable risk factors (i.e. excess consumption of alcohol, smoking, malnutrition, high dietary protein, soft drinks, PPIs etc).  

As tobacco smoking and high alcohol intake have been linked with osteoporosis, smoking cessation and moderation of alcohol intake are commonly recommended as ways to help prevent it.
The diet must ensure optimal calcium intake (of at least one gram daily) and measuring vitamin D levels is recommended, and to take specific supplements if necessary.

Nursing Considerations for Osteoporotic Patient:
1.    Assess patient’s functional ability for mobility and note changes.
2. Provide range of motion exercises in every shift. Encourage active range of motion exercises. Reposition patient every 2 hours.
3. Use mechanical lift for patients who cannot bear weight, and help them out of bed at least daily.
4. Instruct family regarding Range of Motion (ROM) exercises, methods of transferring patients from bed to wheelchair, and turning at routine intervals.
5. Monitor blood pressure (BP) with resumption of activity. Note reports of dizziness.
6. Auscultate bowel sounds. Monitor elimination habits and provide for regular bowel routine. Place on bedside commode, if feasible, or use fracture pan. Provide privacy.
7. Encourage increased fluid intake to 2–3 L per day.
8. Provide diet high in proteins, carbohydrates, vitamins, and minerals, limiting protein content until after first bowel movement.
9.    Evaluate the patient’s entire collection of medications, including over-the-counter drugs, vitamin and mineral supplements, herbal remedies, and dietary regimen.
10.    Administer analgesics and hot compression to relieve pain.
11. Monitor lab work for toxicity levels, imbalances of electrolytes.
12.    Reassure the patient and his relatives in all phases of care.
13.    Encourage the patient to perform as much self-care as her immobility and pain allow.
14.    Provide the patient activities that involve mild exercise.
15.    Check the patient’s skin daily for redness, warmth, and new pain areas.
16.    Monitor the patient’s pain level, and assess his/her response to analgesic’s, heat therapy, and diversional activities.
17.    Explain all treatments, tests, and procedure to the patient.
18.    Make sure the patient and her family clearly understands the prescribed drug regimen.
19.    Tell the patient to report any new pain sites immediately, especially after trauma.
20.    Provide emotional support and reassurance to help the patient cope with limited mobility.