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There are approximately 8 million women and 2 million men living with osteoporosis in the United States today, according to the National Osteoporosis Foundation. An estimated 34 million more people have low bone density, a precursor to osteoporosis.

The disease causes bones to become brittle and prone to fracture, and while osteoporosis is both preventable and treatable, it often goes undiagnosed and untreated because it has no symptoms. But under-diagnosis is not the only reason osteoporosis often goes untreated...

A recent study by University at Buffalo researchers shows that even when people are diagnosed with osteoporosis, often they fail to pursue treatment. Nearly half of the 836 women in the population-based study who underwent osteoporosis screening for the first time were found to have osteoporosis. Follow-up, one year later, showed that half of the women diagnosed had not begun treatment to slow progression of the disease, and a quarter of the women diagnosed had failed to discuss the screening results with their physician.

Study results were presented at the annual meeting of the Society for Epidemiological Research this week.

Below, Dr. Martin Nydick and Dr. David Zackson of the New York Presbyterian Hospital-Weill Cornell Medical College, discuss the dangers associated with osteoporosis, and the reasons why a proactive treatment approach is a good idea.

Q: How would you define the disease?
DAVID ZACKSON, MD: Osteoporosis is a disease of the bone in which the bone substance is normal but there's just not enough of it to connect, on a microscopic level, in a normal fashion. This makes the bone much more vulnerable to fractures.

For those who get the disease, it manifests itself as loss of height, which is due to compression fractures of the vertebrae, and increased vulnerability to hip fractures in older age.

Q: Twenty-five million Americans have osteoporosis. What does this mean in the world of American healthcare?
MARTIN NYDICK, MD, FACP: This is a very prevalent disorder. It produces about a million and a half fractures each year and it's been estimated that it may be costing our economy up to or more than twenty billion dollars in healthcare costs. These costs are from nursing homes and other services that are necessary to take care of people after they have fractures, which can be very debilitating.

Q: What is the most dangerous outcome of this disease?
DAVID ZACKSON, MD: Hip fractures are the most devastating result of osteoporosis, and result in the most deaths. There's a death rate increase by twenty-five to thirty percent within the first year after having a hip fracture.

The compression fractures of the spine have a cosmetic disability and sometimes increase backache because of increased curvature and back muscle spasm, as well as some pain at the time of fracture and for four to six weeks after the fracture.

Q: Who is most at risk of getting osteoporosis?
DAVID ZACKSON, MD: Women are most at risk for developing osteoporosis, although men develop it also.

Q: Do you think of it as a disease of aging?
MARTIN NYDICK, MD, FACP: Age is a major factor. For all of us, bone density decreases with age. The older we get, the more time we have to lose bone. Some women develop the disease fairly quickly in the postmenopausal period because the loss of estrogen associated with menopause accelerates bone loss.

Q: Why do decreased levels of estrogen play a role in osteoporosis?
DAVID ZACKSON, MD: Estrogen has a tonic supportive action on bone, and when estrogen levels fall dramatically as they do suddenly in women during menopause, the bone loss is very rapid for the first several years.

Q: What are some of the other important risk factors associated with osteoporosis?
MARTIN NYDICK, MD, FACP: Estrogen deficiency is the most important factor, but there are also some secondary causes. Calcium, of course, plays an important role in developing and maintaining strong bones, so a calcium deficiency puts one at risk of the disease. People who smoke or drink excessive amounts of alcohol are also at risk. And the disease is much more common in Caucasian and Asian populations. It is also very common in people who are on certain medications, such as corticosteroids, thyroid medication, and anticonvulsants. And finally, people of slight build are also very prone to osteoporosis.

Q: What might be a good parting message for those just learning about this important disease?
MARTIN NYDICK, MD, FACP: People are becoming more and more aware of osteoporosis and what it can do to the body. But only about twenty percent of the people who have the disease are diagnosed and treated. I encourage people to read up on osteoporosis, get familiar with the risks and the prevention techniques, and finally, to talk with their doctors. The first line of defense against this disease is education.