It is more common as age advances, in post-menopausal females, chronic smokers and alcoholics, those taking corticosteroids or have blood cancer. The bones become weak and easily break with minor injuries and fall. The backbone and leg bones are commonly affected. A diet low in calcium is also a contributing factor. The diagnosis is made by a test called bone-mass-density (BMD) and its unit is T-Score. A T-Score less than 2.5 is considered to be significant. Non-drug Treatment: A calcium rich diet having about 1000-1500 mg should be taken daily. Simultaneously protein intake is increased, but put a limit on salt, meat and coffee/tea, these increase calcium excretion! Regular exercises which strengthen muscles also reduces the risk of fractures due to falls. Overweight patients should reduce their weight (try to reach and maintain normal weight). Avoid smoking and chewing tobacco. Reduced alcohol intake and cessation of smoking are important life style changes for the health of bones.Drugs and Supplements Calcium Supplements Regular intake of calcium partly reduces the rate of loss of bone density in post menopausal women.By studying the above table we understand that if 1 g of calcium carbonate is taken, 400mg elemental calcium is available. Foods high in phytate and oxalate (wheatbran, spinach, rhubarb, almonds, beans and peas) reduce absorption of calcium. Therefore, calcium salts should not be taken with these. Calcium from oyster shell may contain unacceptably higher lead levels. Although most of the calcium preparations are well tolerated but constipation and gaseousness can occur. Vitamin D About 800 IU of vitamin D taken along with 1 to 1.5 gm of calcium supplements the risk of hip-fracture significantly. A number of formulations have 100-400 IU of vitamin D3 along with calcium salts. In other preparations active form of vitamin (Alpha Calcidol-250 ug) is incorporated. In these doses they are considered to cause no harm.Bighosphonates-Alendronote (Osteophos, Denfos 5 mg) It increases BMD by reducing resorption (removal) of calcium from bones. It should be taken (5mg to 10 mg) in the morning (on empty stomach), swallowed with full glass of water and nothing should be taken (food or other medicines, coffee, tea, juice) for 30-60 minutes. The person stand or sit up-right (without lying down) for half an hour. Adverse Effects: Epigastric pain, heart bum, abdominal distension and pain, diarrhea, constipation, headache and muscle pains. Should be avoided in peptic ulcer. Raloxifene (Ralista Fiona)It is a 'designer-drug. That is, it is designed to act on estrogen-receptors of bones and prevent osteoporosis. Its elder sister Tamoxifen (Mamofen) is designed to act on breast rather than on bones. While its younger sister ormeloxifene (Sevista) is designed to be used in uterine bleeding. Raloxifene should be used in postmenopausal osteoporosis (60 mg/day). It should not be used if there is a past history of leg-vein thrombosis, jaundice and undiagnosed uterine bleeding. It should not be used in males.Sodium Fluoride (Naf tab) It increases formation of bone. Calcitonin (Calsynar) It is a hormone produced by 'c' cells of thyroid gland. It has been used as nasal spray (200 IU) in osteoporosis. Its cost is prohibitive.