Doctor, we refer to it as the silent disease and my question to you is how does someone get osteoporosis? is it genetic? is it age related? hormones? all of the above? Yeah, the answer there is all of the above. With aging you are going to see an increase risk of developing osteoporosis, but also genes play an important role. If we have a family history, one of your relatives who had a hip fracture, for example, then you’re going to have an increased factor. Also for women after menopause or if you are a man with testosterone deficiency you can be at increased risk and environmental factors such as smoking can put you at increased risk too. Looking at that bone that you have over your right shoulder, how does someone know or maybe they don’t that they have that situation going on, or do something unfortunate have to happen like a fall, a bump? Very important point. When the architecture of your bone gets affected, you will not always notice, you won’t always note, which is why it is so important to screen for this disease and those high risks as we get older. Unfortunately, symptoms may not come until you have a fracture and it is recognized that as much as one thrid of the spinal fractures don’t have symptoms until later on you start to develop some back pain and that’s maybe your first sign, but that can happen months after your fracture.