Osteoporosis is divided into the following categories depending on cause and course:

1. Primary osteoporosis:
   Affects mainly women after menopause (postmenopausal osteoporosis) and older men (senile osteoporosis).
2. Secondary osteoporosis:
   Caused by other diseases or medications, such as endocrine disorders, chronic inflammations, or long-term cortisone therapy.
3. Idiopathic osteoporosis:
   Occurs in young people without a recognizable cause. 

The causes of osteoporosis are varied and depend on the type of the condition:

• Hormonal changes:
  • Estrogen deficiency after menopause is a major cause of primary osteoporosis.
  • In men, a testosterone deficiency can lead to a reduction in bone density.
• Genetic factors:
  • A family history suggests a genetic predisposition.
• Nutritional deficiencies:
  • A deficiency of calcium, vitamin D, or protein can reduce bone strength.
• Medications:
  • Long-term use of glucocorticoids or antiepileptic drugs increases the risk.
• Lifestyle:
  • Lack of exercise, smoking, and excessive alcohol consumption impair bone structure.
• Diseases:
  • Diseases such as rheumatoid arthritis, hyperthyroidism or chronic kidney disease promote the development of osteoporosis.

Osteoporosis often remains asymptomatic for a long time and is frequently only discovered after a fracture. Possible symptoms include:

• Fractures from minor trauma:
  Fractures of the vertebral bodies, hip, or wrist occur even with small stresses or falls.
• Back pain:
  Pain due to vertebral body fractures or muscle tension.
• Loss of height:
  Shrinking due to vertebral body fractures and changes in posture.
• Hunched back (kyphosis):
  Curvature of the spine that can lead to a limitation of mobility.
• Feeling of weakness:
  General weakness and unsteadiness when walking due to reduced stability of the skeleton.

The diagnosis is made through a combination of medical history, clinical examination, and special tests:

1. Medical history:
   The physician inquires about risk factors, pre-existing conditions, and family history.
2. Clinical examination:
   Assessment of posture, height, and mobility as well as the location of pain.
3. Bone density measurement (DXA):
   Gold standard for determining bone density and assessing fracture risk.
4. Blood and urine tests:
   Assessment of calcium and vitamin D levels as well as other markers of bone metabolism.
5. Imaging methods:
   • X-ray: Visualization of vertebral body changes and fractures.
   • MRI: Detailed assessment of bone marrow changes and fractures.

To prevent osteoporosis, the following measures are recommended:

1. Balanced diet: Adequate intake of calcium, vitamin D, and protein.
2. Regular physical activity: Promoting bone density through weight training and low-impact sports.
3. Avoidance of risk factors: Refrain from smoking and excessive alcohol consumption.
4. Fall prevention: Securing the home environment and balance training.
5. Early detection: Regular check-ups for at-risk groups, especially postmenopausal women and older adults.