According to the National Osteoporosis Foundation every 20 seconds osteoporosis causes a fracture. An equally alarming statistic is that 71 per cent of those with osteoporosis are not even diagnosed, leaving them at an increased risk for a fracture.

It is a disease that is more common amongst women than men and one in four women and one in eight men over the age of 50 will have an osteoporotic fracture in their lifetime.

May is Osteoporosis month and the Bermuda TB Cancer and Health Association is trying to raise awareness of the disease which has been described as a silent disease, often undetected until multiple fractures have occurred. But the Bone Mineral Density (BMD) test which detects the disease is painless, simple and quick and is the most accurate way to assess bone health.

It costs $134 and is covered by insurance, but the patient must be referred by a doctor. You simply lie on the Bone Dessity table while the technologist scans your lumbar spine and hip (sometimes also your forearm). DEXA (dual energy x-ray absorptiometry) has very low radiation exposure and is equal to one-tenth the exposure from one chest x-ray.

"As a result of new medications, osteoporosis can now be effectively treated,'' assured Radiologist Dr. Ian Harvey.

"Early detection of bone loss will initiate preventative measures. If bone loss continues, therapy can be started.'' Fractures due to osteoporosis can lead to chronic pain, loss of independence and, in the case of hip fractures, can be life-threatening.

One in every five persons who has a hip fracture will not survive more than one year. This is usually attributed to complications of the fracture or surgery as patients are often bed-ridden and develop pneumonia or blood clots in the lungs.

Another 75 per cent will suffer from some form of permanent disability. A quarter of these patients will require long term care and one half will be unable to walk or move as before.

Osteoporosis poses a lifetime risk of death comparable to that of breast cancer and osteoporosis fractures are more common than stroke, heart attack and breast cancer combined.

Women of Caucasian and Asian descent are at increased risk of having osteoporosis, but people of all races and gender may develop the disease.

Those in the following categories are at risk: any adult who has suffered a low trauma fracture menopausal women family history of the disease thin or small build inactive lifestyle low calcium intake (under 1000 mg per day) steroid therapy and/or certain other medications thyroid disorder smoking (past or present) excessive alcohol or caffeine According to the National Osteoporosis Foundation, the general public mistakenly believes that stooped posture and osteoporosis, in general, are normal parts of aging and that osteoporosis is only a concern for the very old.

Unlike hip fractures which tend to occur after the age of 65, the risk of vertebral fractures increase once a woman enters menopause, which occurs on average around age 50.

In addition to the risk of fracture, common signs and symptoms of osteoporosis include: unexplained back pain, height loss, history of recurrent fracture or fracture resulting from minimal trauma and humped back or `dowager's hump'.

Patricia Rowse, a radiographer at TB and Cancer Association, explains how bones gradually become weaker and more brittle with age, which makes them more likely to break.

"During your whole life you are building bone and destroying bone, it's called remodelling process and women in particular, as they reach monopause, their oestrogen levels drop so they destroy bone at the same rate but don't make it as fast,'' said Mrs. Rowse. "What happens as you get older and your bone weakens your tendency to fall becomes more. Your spine curves more and because your spine is curving more you put your chin out so that you can see straight and that throws your whole centre of gravity off and you are more likely to fall.'' Mrs. Rowse has erected a board at the Bermuda TB and Cancer Association with information on osteoporosis in a bid to raise awareness.

Women and men should prepare for osteoparosis "I got more of it from a course I went to in Toronto, at the Michener Institute, in February,'' explained Mrs. Rowse who does bone densitometry testing as well as mammography.

"From the few people that we have tested, the number that we have found to be osteopenic (early-stage osteoporosis) and osteoporotic are quite high, but whether it's because we are just testing people who have a lot of risk factors or whether the population here has a high number, I don't know.

"If someone is diagnosed with osteoporosis or osteopenia what we do is suggest to the physician that sent them that they do some type of osteoporosis counselling, which hopefully involves telling them how much calcium they need.

"Most postmenopausal women, not on hormone replacement therapy, need 1500mg of calcium every day and if you do take take hormone replacement you'll need 1000mg.'' Weight bearing exercise, too, is very important, she stressed.

"The weight puts a certain resistence against the bone and stimulates them to grow,'' Mrs. Rowse explained. "If the bone in the spine are weak than you can do spinal strengthening exercises. What I'm finding is people who walk and run have very strong hips but not necessarily strong spines, so they need to do all over body strengthening.

"There are different drugs you can take if you are osteoporotic but obviously you need to discuss this with your doctor. What hormone replacement therapy does is stop you from losing any more bone but it won't help you build up bone.'' Mrs. Rowse suggests people in their 40s should be tested.

"The general guideline is everybody perimenopausal or postmenopausal should have a test to see where they're at,'' she said.

"I would like to see anybody at least 40 have a test done. If you never reach your peak bone density -- you peak around 30 or 35 -- then you're not going to have as far to `fall' when you get to menopause. I would like to see a baseline done relatively early to make sure that people are reaching their peak bone density.'' She also noted that men start out with a higher peak bone density than women.

"So even though they do lose density they have more to lose,'' she pointed out.