INTRODUCTION

According to ferdous et al. (2016), Osteoporosis is a developing systemic skeletal disease

characterised by reduced bone mass /density and micro-architectural deterioration of bone tissue.
Bone formation initially exceeds bone resorption. the third decade passed it results to a net loss
of bone mass. it may increase the bone fragility and susceptibility to fracture. a lot of patients
presenting with an injured cause by a fall from standing height. patient with these fragility
fractures are not started on therapy. Osteoporotic (Fragility) fractures are result from reactive
forces that would not ordinarily result to fracture. Osteoporosis Fractures interpret as fractures
associated with low bone mineral density (BMD) that may include spine, forearm, hip and
shoulder. (https:/www.researchgate. net/publication /304495902_Osteoperosis_A_Review.)

Osteoporosis is characterized by a reduction of bone mass, leading to greater bone

fragility, which increases the risk of bone breakage, also known as fracture.Fractures most
commonly associated with osteoporosis occur in the hip or spine, often leading to a downward
spiral in physical and mental health, which may seriously affect the quality of life and may lead
to death.The word osteoporosis literally means "porous bones." This happens when bones lose
excessive protein and mineral content, especially calcium.In mostly cases of bone diseases, thee
are actually two types of bone diseases in which there are classified depending on their amount
of calcification or density of bone. As people get older, bone strength decreased, and it becomes
thinner and makes the bone weaker. Osteopenia is defines as having a bone density of between
10 to 25 percent below the normal average levels. While Osteporosis is define as having a bone
density of more than 25 percent below of normal average levels. The first diagnosis of bone
decreased of calcification is termed as osteopenia in which it is a milder degreee of bone loss, it
is not yet severe and could still be prevented. But if osteopenia is not treated properly, it could
lead to osteporosis in which this is a more serious condition of bone breakage because trabecular
bone is impared and cortocal bone becomes more thinner which makes it more break easily.

( https://shodhganga.inflibnet.ac.in/bitstream/10603/70686/17/chapter%202.pdf)
 A part of our body is completed mostly of collagen, it delivers a soft framework in a form
of protein and give calcium phosphate in which a mineral that enhances strength and strengthens
the framework. This part of the body is the bone in which it is identify as living and growing
tissue. The mixture of collagen and calcium makes bone both flexible and strong, which in turn
helps bone to withstand stress. More than 99 percent of the body’s calcium is contained in the
bones and teeth. The remaining 1 percent is found in the blood. Throughout one’s lifetime, old
bone is removed, and new bone is added to the skeleton. During childhood and teenage years,
new bone is added faster than old bone is removed. As a result, bones become larger, heavier,
and denser. Bone formation outpaces resorption until peak bone mass is reached, typically by the
late 20s. After that time, bone resorption slowly begins to exceed bone formation. For women,
bone loss is fastest in the first few years after menopause, and it continues into the
postmenopausal years. Osteoporosis – which primarily influences ladies but may moreover
influence men – will create when bone misfortune happens as well rapidly or when bone
arrangement happens as well gradually. Osteoporosis is more to be expected to grow if you did
not range optimal peak bone mass during your bone-building
years.(https://www.bones.nih.gov/health-info/bone/osteoporosis/overview)

As stated by Basaran et al. (2017) It was evaluated that the number of patients around
the world with osteoporotic hip breaks is more than 200 million. It was detailed that in both
Europe and the Joined together States, 30% ladies are osteoporotic, and it was assessed that
40% post-menopausal ladies and 30% men will encounter an osteoporotic break within the rest
of their lives. Osteoporosis is additionally an imperative wellbeing issue in Turkey, since the
number of more seasoned individuals is expanding. The rate for hip break increments
exponentially with age in all countries as well as in Turkey, which is obvious within the FRACTURK
consider. It was assessed that around the age of 50 a long time, the likelihood of having a hip
break within the remaining lifetime was 3.5% in men and 14.6% in ladies.

Majority of osteoporotic fractures are cause by falls; therefore, it is a need for the
structured for the efficient treatment of osteoporosis in order to prevent falls like program. Older
and frail persons especially who those who are experiencing stroke and taking medications that
lessen mental alertness are particularly predisposed near falls. On the other hand, several
interventions reduce the risk of falling but unfortunately none of them reduce the risk of fractures.
Hip protectors are a must nowadays for people who are experiencing osteoporosis because reduce
the risk of fracture, but it does not reduce the risk of falling. Patients at an older age with sever
kyphosis, back discomfort and gait instability could benefit from weight-bearing exercises, back
strengthening, and balance training therapies.

Bone quality can be characterized utilizing BMD (70%) and bone quality (20%). It is simple
to measure Bone Mineral Density (BMD), but, in clinical settings, bone quality isn't quantifiable
however. The determination of osteoporosis is set up by the estimation of BMD or by the event
of a fragility break of the hip or vertebra or within the nonappearance of major injury (e.g., engine
vehicle mishap or drop from numerous stories). Research facility testing uncovered no auxiliary
causes of osteoporosis. Bone mineral thickness can be effectively measured to identify bone
thickness, but the degree of disintegration of the bone tissue cannot be measured in clinical
settings, except for the biochemical markers of bone tissue.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335887/)

According to Lorentzon and Cummings (2015). In 1822 land surgeon and anatomist Sir
Astley Paston Cooper wrote on an observed association with distorted bones and fractures. Jean
Lobstein, a French pathologist and surgeon, was the primary to use the word ' osteoporosis' in
1835, although he identified a disease of blue-gray sclera, which was possibly an incomplete sort
of osteogenesis.In 1941, after the loss of ovarian function Fuller Albright reported cases of ladies
with vertebral fractures. Oestrogen therapy restored those women's calcium balance and reversed
their height loss 7. Such results were the premise for identifying postmenopausal osteoporosis,
and therefore the connection between osteoporosis and vertebral fractures was identified.Several
subsequent studies have shown that vertebral fractures indicate reduced bone strength and
structural bone deterioration. Vertebral fractures represent the extent of osteoporosis and are
effective predictors of potential fractures, making them a trademark of disease 8, 9.