Osteoporosis (Porous Bone disease, Asthi Soushirya)

Osteoporosis

(Fragility Fracture / Porous Bone disease, Fragile bone tissue. Asthi Soushirya, अस्थि क्षय)

“Brace Your Bones”

"OSTEOPOROSIS CAUSES BONE TO BECOME WEAK AND BRITTLE."

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Osteoporosis means “porous bone.” Did you know that calcium keeps you looking young and beautiful. Here's how? Like many women, you may know that the minimum daily calcium requirement is 1,000 milligrams (mg) for women of 50 and younger and 1,200 mg for women over 50. Adequate calcium is necessary for good health, and not just because it's a major component of our bones. It also plays a vital role in keeping our organs and skeletal muscles working properly. The body gets the calcium it needs for basic functions by releasing the calcium stores in our bones into the blood through bone remodeling - the process by which bone is constantly broken down and rebuilt. If your body doesn't get enough calcium, it takes it from your bones making them weak and putting you at risk of osteoporosis.

"BONE IS A LIVING TISSUE THAT IS COSTANTLY BEING BROKEN DOWN AND REPLACED."

Today many youngsters, adults and elderly complain about pain in joints and back region. after their radiological examination and clinical co-relation, usually osteoporosis is diagnosed. Due to wrong dietary habits and lack of physical exercise, this disease is becoming a major health problem in the society. Due to the food habits and heredity factors, Caucasians (white-skinned persons of European origin.) are more pone than Asians. Poor diet which is not nutritional, increases air element / wind (Vayu) and decreases the firmness. Osteoporosis become more common with age. 70-80% are affected. It is more common in women than men. 4:1 ratio.

"BONE USE IT OR LOSE IT"

Introduction

The word “Osteoporosis” literally means porous or honeycombed bones. Reduction of bone mass per unit volume without gross alteration in the bones chemical composition is called Osteoporosis. In short, when hard bone mass is reduced and porous structure is increased, osteoporosis is developed. It is a degenerative condition. In this disorder, the bones of skeletal become fragile due to excessive loss of bone tissue. It may cause the bones to fracture more easily than they should. If the disease affects the spine, it may lead to the collapse of vertebral bodies and consequent deformity. The bones commonly affected are wrist bones, spines and hip bones. Bones becomes porous, or less dense, with age.

Bone is a dynamic living tissue that is constantly been broken down and rebuilt, a process known as remodeling. In females due to pregnancy, menstruation and menopause there is more demand of calcium. Postmenopausal women are the most vulnerable victims of osteoporosis as the production of estrogen, the hormone that enables absorption of effective calcium stops.

The bones in your body are very much alive! Bones are made of a mix of hard material (calcium) that gives them strength and tones of living cells, which help them, grow and repair themselves. Like other cells in your body, the bone cells rely on blood to keep them alive. Blood brings them food and oxygen and takes away waste. Your bones help you out every day and make sure you take care of them.

What is calcium and what does it do?

The word calcium is derived from a Latin word 'cal' meaning lime powder (चूना ) . which is good for bone health. Body's 99% of calcium is required for bones and teeth. We should have sufficient amount of calcium in our body to keep our bones and teeth strong. Enough of calcium metabolism in the body is a must. Sufficient amount of calcium should also be absorbed in the body. 0.9% of calcium remain in the tissues. And .1 % of the calcium flows in the blood.

Calcium plays a major role in providing firmness and elasticity to the skin as well as all the tissues and cells of the body- helping you stay strong and look beautiful. Calcium rich food can also deter acne. Calcium is essential in building bone. Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium enables our blood to clot, our muscles to contract and our heart to beat. About 90% of calcium in our bodies is in our bones and teeth.

Every day we lose calcium through our skin, nails, hair, sweat, urine & feces. Our bodies cannot produce its own calcium. That's why it's important to get enough calcium from the food we eat. When we don't get the calcium our body needs, it is taken from our bones. This is fine once in a while, but if it happens too often, bone get week and easier to break. It all eventually lead to bone loss, low bone density and even broken bones.

AGE & BONE MASS

Calcium is essential for many diverse processes in the body, including bone formation. muscle contraction, enzyme and hormone functioning. Inadequate calcium consumption by pregnant woman can lead to adverse effects in the mother as well as the fetus and produce osteopenia, ( condition in which the protein and mineral content of bone tissue is reduced). (typically tingling or pricking or pins and needles) muscle cramping, tetanus, delayed fetal growth, low birth weight and poor foetal mineralization.

Vitamin D

Vitamin D helps the body in calcium absorption and augments bone health. When the body is exposed to sunlight, it converts cholesterol into vitamin D. Therefore the easiest cure for osteoporosis is generous exposure of the body to the Sunlight for 30 minutes every day.

“Bones are precious jewels of our body maintaining healthy and strong bones is like acquiring a great treasure.

Calcium Deficiency

Calcium deficiency leads to irritability, jitteriness, tremors and convulsions in newborn babies. It can also be seen in older infants and pre-school children in association with vitamin D deficiency. Pregnant and lactating mothers must have adequate amount of calcium and vitamin D in their diets to prevent problem associated with calcium deficiency. Artificially fed children are more prone to develop calcium deficiency. The high phosphate content of non-human milk depresses the level of calcium in blood. Though rare in breastfed infants, calcium deficiency can occur in such infants whose mothers are deficient in calcium and vitamin D. Rickets is caused due to calcium deficiency.

Cause

Post - menopausal Bone loss increases after the menopause due to lower levels of estrogen, and after Andropause due to lower levels of Testosterones
Heredity If a person is having history of osteoporosis then he/she is more suspicious to get affected.
Drugs Prolonged use of steroids ( in Asthma) and some medicines such as anti-convulsant , lead to osteoporosis.
Immobilization Prolonged bed rest and total lack of activity , specially in elders.
Gender Females are more prone than males. In males the bone cell components and the structure of bone cells is harder, firm in make, compared to females. after delivery, the calcium level in female gets reduced.
Nutritional a) Altered and insufficient diet. b) Poor calcium intake. c) Poor calcium absorption.
Low body weight/ body’s inability to absorb and utilize nutrients
Prolonged deficiency of calcium and vitamin D
Sedentary lifestyle/ unhealthy diet
Smoking/ chronic alcoholism
Crash dieting/ nutritional deficiency
Elderly Aged people are likely to get osteoporosis as a degenerative change.
Inadequate sunlight exposure
Disease like Alcoholism, Hyperthyroidism, anorexia, Kidney diseases.
Surgical removal of ovaries.
Medications like antiseizure, chemotherapy, glucocorticosteroids.
According to Ayurveda, it is considered as a metabolic disorder related to the formation of bones. As osteoporosis is a Vata/ Kapha predominant disease. The "Gramyahara" i.e. improper diet leads to the deformities in bones and muscles. Excessive salty, spicy, fermented food alters the production of Asthi (bones). The food which contains preservatives; alkaline substances if consumed more, destroys the bone tissues and increases its porosity. On the contrary the smooth, oily; soft, sweet and nutritious food helps in prevention of porosity. Intake of toxic substances like tobacco, cigarettes , alcohol and coffee also increases porosity .

"Until a broken bone occurs there are typically no symptoms. After the broken bone heals, the person may have chronic pain and a decreased ability to carry out normal activities"

Sign & Symptom

Fractures are common symptoms of osteoporosis and can result in disability.
Pain : Acute and chronic pain in the elderly due to osteoporosis.
Sudden back pain
Tiredness
Hunchback, A gradual loss of height

Kyphosis

Lame : Severe pain in elderly patient i.e. joints, bones and limb
Rounding off the shoulders

Rounding of shoulders

Gum inflammation, Falling of teeth

Gum disease

Acute lower backache/ spasms of back muscles
Swelling of a wrist, after a minor fall or injury
Constant trouble with nails, hair, teeth, gums, joints, or back
Nocturnal leg cramps/spinal disc collapse

Leg Cramps

Bone degeneration :Compound fracture after a simple fall
Aching of long bones/ thinning of pelvic bone/feeling of emptiness of bones.
Loss of twisting and bending strength
Frequent occurrence of spontaneous fracture
Numbness, tingling fingers, muscles cramps, lethargy poor appetite, weak or brittle finger nails, dry skin.

Weakness of bone, loss of elasticity of joints
Insomnia, vertigo, blackouts.

Insomnia

Looseness of major joints
Loosening of teeth, Falling of hairs, and eye lashes.

Hair Fall

Dry skin : Due to vata vitiation

Dry skin

Cracking of teeth.

Cracked tooth

Dryness of mouth

Dry mouth

Anemic condition. Emaciation of muscle
Emaciation of muscles

Fractures

Spine Compression Fracture

Hip Fracture

The most common osteoporotic fractures are of the wrist, spine, shoulder and hip. The symptoms of a vertebral collapse ("compression fracture") are sudden back pain, often with radicular pain (shooting pain due to nerve root compression) and rarely with spinal cord compression or cauda equina syndrome . Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility.

Fractures of the long bones acutely impair mobility and may require surgery. hip fracture, in particular, usually requires prompt surgery, as serious risks are associated with it, such as deep vein thrombosis and pulmonary embolism, and increased mortality.

Fracture risk calculators assess the risk of fracture based upon several criteria, including bone mineral density, age, smoking, alcohol usage, weight, and gender.

The term "established osteoporosis" is used when a broken bone due to osteoporosis has occurred. Osteoporosis is a part of fragility syndrome.

Progression of the shape of vertebral column with age in Osteoporosis

“Osteoporosis can be prevented and treated”.

Osteoporosis Location

Spine & Hip

Pathogenesis

The underlying mechanism in all cases of osteoporosis is an imbalance between bone absorption and bone formation In normal bone, matrix remodeling of bone is constant; up to 10% of all bone mass may be undergoing remodeling at any point in time. Osteoclasts are assisted by transcription factor PU.1 to degrade the bone matrix, while osteoblast rebuild the bone matrix. Low bone mass density can then occur when osteoclasts are degrading the bone matrix faster than the osteoblasts are rebuilding the bone.

The three main mechanisms by which osteoporosis develops are an inadequate peak bone mass (the skeleton develops insufficient mass and strength during growth), excessive bone resorption, and inadequate formation of new bone during remodeling, likely due to mesenchymal stem cells biasing away from the osteoblast and toward the marrow adipocyte lineage. An interplay of these three mechanisms underlies the development of fragile bone tissue. Hormonal factors strongly determine the rate of bone resorption; lack of estrogen (e.g. as a result of menopause) increases bone resorption, as well as decreasing the deposition of new bone that normally takes place in weight-bearing bones. The amount of estrogen needed to suppress this process is lower than that normally needed to stimulate the uterus and breast gland . The α-form of the estrogen receptor appears to be the most important in regulating bone turnover. In addition to estrogen, calcium metabolism plays a significant role in bone turnover, and deficiency of calcium and vitamin D leads to impaired bone deposition; in addition, the parathyroid glands react to low calcium levels by secreting parathyroid hormone (parathormone, PTH), which increases bone resorption to ensure sufficient calcium in the blood. The role of calcitonin, a hormone generated by the thyroid that increases bone deposition.

Trabecular bone (or cancellous bone) is the sponge-like bone in the ends of long bones and vertebrae. (Trabecular bone tissue is a hierarchical, spongy, and porous material composed of hard and soft tissue components which can be found at the epiphyses and metaphysis of long bones and in the vertebral bodies) Cortical bone is the hard outer shell of bones and the middle of long bones. Because osteoblasts and osteoclasts inhabit the surface of bones, trabecular bone is more active and is more subject to bone turnover and remodeling. Not only is bone density decreased, but the microarchitecture of bone is also disrupted. The weaker spicules of trabecular bone break ("microcracks"), and are replaced by weaker bone. Common osteoporotic fracture sites, the wrist, the hip, and the spine, have a relatively high trabecular bone to cortical bone ratio. These areas rely on the trabecular bone for strength, so the intense remodeling causes these areas to degenerate most when the remodeling is imbalanced. Around the ages of 30–35, cancellous or trabecular bone loss begins. Women may lose as much as 50%, while men lose about 30%.

Light micrograph of an osteoclast displaying typical distinguishing characteristics: a large cell with multiple nuclei and a "foamy" cytosol.

Light micrograph of osteoblasts,

Collapse of vertebra on right, normal on left due to fracture

"All women 65 years of age or older be screened by Bone densitometry and screening younger women with risk, BMD testing for men 70 or older.".

Diagnosis

History of fracture
X - Ray : The diagnosis of osteoporosis can be made using conventional radiography
By measuring Bone Mineral Density : : Bone Mineral Density Scan Osteoporosis is defined as a bone density of 2.5 standard deviation below that of a young adult. This is typically measured by dual-energy X-ray absorptiometry (DEXA Scanner). It measures bone mineral density (BMD) using spectral imaging. Two X- ray beams with different energy levels, are aimed at patient's bones. When soft tissue absorption is subtracted out the BMD can be determined from the absorption of each beam by bone. The DXA scan is typically used to diagnose and follow osteoporosis, as contrasted to the nuclear bone scan, which is sensitive to certain metabolic diseases of bones in which bones are attempting to heal from infections, fractures, or tumors. It is also sometimes used to assess bone composition.

DXA / DEXA Scanner

Dual-energy X-ray

Dual - energy X- Ray absorptiometry (DEXA scan) is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old), healthy adult women reference population. This is translated as a T - score . But because bone density decreases with age, more people become osteoporotic with increasing age. The World Health Organization has established the following diagnostic guidelines:

Category	T-score range	% young women
Normal	T-score ≥ −1.0	85%
Osteopenia	−2.5 < T-score < −1.0	14%
Osteoporosis	T-score ≤ −2.5	0.6%
Severe osteoporosis	T-score ≤ −2.5 with fragility fracture

The International Society for Clinical Densitometry takes the position that a diagnosis of osteoporosis in men under 50 years of age should not be made on the basis of densitometric criteria alone. It also states, for premenopausal women, Z-scores (comparison with age group rather than peak bone mass) rather than T-scores should be used, and the diagnosis of osteoporosis in such women also should not be made on the basis of densitometric criteria alone.

Quantitative Ultrasound

Calcaneus heel bone

Quantitative ultrasound has many advantages in assessing osteoporosis. The modality is small, no ionizing radiation is involved, measurements can be made quickly and easily, and the cost of the device is low compared with DXA and QCT devices. The calcaneus is the most common skeletal site for quantitative ultrasound assessment because it has a high percentage of trabecular bone that is replaced more often than cortical bone, providing early evidence of metabolic change. Also, the calcaneus is fairly flat and parallel, reducing repositioning errors. The method can be applied to children, neonates, and preterm infants, just as well as to adults. Some ultrasound devices can be used on the tibia.
Tibia

Biomarkers

Chemical biomarkers are a useful tool in detecting bone degradation. The enzyme cathepsin K breaks down Type -1 collagen, an important constituent in bones. Prepared antibodies can recognize the resulting fragment, called a neoepitope, as a way to diagnose osteoporosis. Increased urinary excretion of C-telopeptides, a type-I collagen breakdown product, also serves as a biomarker for osteoporosis.

Conventional radiography

The main radiographic features of generalized osteoporosis are cortical thinning and increased radiolucency. Frequent complications of osteoporosis are vertebral fractures for which spinal radiography can help considerably in diagnosis and follow-up. Vertebral height measurements can objectively be made using plain-film X-rays by using several methods such as height loss together with area reduction, particularly when looking at vertical deformity in T4-L4, or by determining a spinal fracture index that takes into account the number of vertebrae involved. Involvement of multiple vertebral bodies leads to kyphosis of the thoracic spine, leading to what is known as dowager's hump.

Fracture head of Femur

Osteoporosis is perfectly diagnosed with the help of bone density measurement machine
Bone mass measurement
Dual photon absorptiometry (DPA)
Dual energy X-ray absorptiometry (DEXA) are used to measure the bone mass of spine and femoral neck.
CT or MRI scan

Fracture risk assessment

In the absence of risk factors other than sex and age a BMD measurement using dual-energy X-ray absorptiometry (DXA) is recommended for women at age 65. For women with risk factors a clinical FRAX is advised at age 50.

Blood Test : Depending on the likelihood of an underlying problem, investigations for cancer with metastasis to the bone, multiple myeloma, Cushing's disease and other above-mentioned causes may be performed.

Risk of fall

Ankle injury due to fall

Foot

There is an increased risk of falls associated with ageing. These falls can lead to skeletal damage at the wrist, spine, hip, knee, foot and ankle. Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with gait or balance disorders, are most at risk.

Complication

In addition to making you more susceptible to breaks and fractures, osteoporosis can lead to other complications. Bone fractures which are results from osteoporosis can lead to disability and even an increased chance of death after the injury.
Depression is considered to a complication of osteoporosis. People with osteoporosis lose independence and risk being isolated due to less physical activity. This will further hinder the ability to manage health issues.
Osteoporosis is also linked to respiratory and cardiovascular health issues, such as loss of lung capacity. Multiple fractures lead to a collapsed thoracic spine, which makes less air being able to move into the lungs. Every thoracic vertebral body collapsed results in the loss of nearly 10% of lung volume.

Risk Factors

Non Modifiable

The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; estrogen deficiency following menopause or surgical removal of ovaries is correlated with a rapid reduction in bone mineral density, while in men, a decrease in testosterone levels has a comparable (but less pronounced) effect.
Ethnicity: While osteoporosis occurs in people from all ethnic groups, European or Asian ancestry predisposes for osteoporosis.
Heredity: Those with a family history of fracture or osteoporosis are at an increased risk; the heritability of the fracture, as well as low bone mineral density, is relatively high, ranging from 25 to 80%. At least 30 genes are associated with the development of osteoporosis.
Those who have already had a fracture are at least twice as likely to have another fracture compared to someone of the same age and sex.
Build: A small stature is also a nonmodifiable risk factor associated with the development of osteoporosis.

Modifiable

Excessive alcohol: Chronic heavy drinking (alcohol intake greater than three units/day) probably increases fracture risk despite any beneficial effects on bone density.
Vitamin D deficiency : Low circulating Vitamin D is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased parathyroid hormone (PTH) production. PTH increases bone resorption, leading to bone loss. A positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone mineral density, while PTH is negatively associated with bone mineral density.
Tobacco Smoking : Tobacco smoking has been proposed to inhibit the activity of osteoblasts, and is an independent risk factor for osteoporosis. Smoking also results in increased breakdown of exogenous estrogen, lower body weight and earlier menopause, all of which contribute to lower bone mineral density.
Malnutrition : Nutrition has an important and complex role in maintenance of good bone. Identified risk factors include low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, vitamins A, K, E and C (and D where skin exposure to sunlight provides an inadequate supply). Excess sodium is a risk factor. High blood acidity may be diet-related, and is a known antagonist
A diet high in protein may be optimal for bone health, as higher protein diets tend to increase absorption of calcium from the diet and are associated with higher bone density.
Underweight/ inactive : Bone remodeling occurs in response to physical stress, so physical inactivity can lead to significant bone loss. Weight bearing exercise can increase peak bone mass achieved in adolescence, and a highly significant correlation between bone strength and muscle strength has been determined. The incidence of osteoporosis is lower in overweight people.
Endurance training: In female endurance athletes, large volumes of training can lead to decreased bone density and an increased risk of osteoporosis. This effect might be caused by intense training suppressing menstruation, producing amenorrhea, and it is part of the ^{female athlete traid.} However, for male athletes, the situation is less clear, and although some studies have reported low bone density in elite male endurance athletes, others have instead seen increased leg bone density.
Heavy metals : A strong association between cadmium and lead with bone disease has been established. Low-level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone)
Soft drinks: Soft drinks (many of which contain phosphoric acid ) may increase risk of osteoporosis, at least in women.
Proton pump inhibitors (such as lansoprazole, esomeprazole, and omeprazole), which decrease the production of stomach acid are a risk factor for bone fractures if taken for two or more years, due to decreased absorption of calcium in the stomach.

Medical Disorders

In general, immobilization causes bone loss (following the 'use it or lose it' rule). For example, localized osteoporosis can occur after prolonged immobilization of a fractured limb in a cast. This is also more common in active people with a high bone turn-over (for example, athletes). Other examples include bone loss during space flight or in people who are bedridden or use wheelchairs for various reasons.
Hypogonadal states can cause secondary osteoporosis. These include Turners syndrome, Klinefelter syndrome, anorexia nervosa, andropause, hypothalamic or amenorrhea or hyperprolactemia. In females, the effect of hypogonadism is mediated by estrogen deficiency. It can appear as early menopause (<45 years) or from prolonged premenopausal amenorrhea (>1 year). Bilateral oophorectomy (surgical removal of the ovaries) and premature ovarian failure cause deficient estrogen production. In males, testosterone deficiency is the cause (for example, andropause or after surgical removal of the testes).
Endocrine disorders that can induce bone loss ^{include, Cushing's syndrome, hyper parathyroids, hyperthyroidism, diabetes mellitus, type 1 and 2, acromegaly and adrenal insufficiency.}
Malnutrition, parenteral nutrition and malabsorption can lead to osteoporosis. Nutritional and gastrointestinal disorders that can predispose to osteoporosis include undiagnosed and untreated coeliac disease (both symptomatic and asymptomatic people), Crohn's disease, ulcerative colitis, cystic fibrosis, surgery (after gastrectomy, intestinal bypass surgery or bowel resection ) and severe liver diseases (especially primary biliary cirrhosis ). People with lactose intolerance or milk allergy may develop osteoporosis due to restrictions of calcium-containing foods. Individuals with bulimia can also develop osteoporosis. Those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium and/or vitamin D. Other micronutrients such as vitamin K, or vitamin B12 deficiency may also contribute.
People with rheumatologic disorders such as rheumatoid arthritis, ankylosing spondylosis, systemic lupus erythematosus and polyarticular juvenile idiopathic arthritis are at increased risk of osteoporosis, either as part of their disease or because of other risk factors (notably corticosteroid therapy). Systemic diseases such as amyloidosis and sarcoidosis can also lead to osteoporosis.
Chronic kidney disease can lead torenal osteodystrophy
Hematologic disorders linked to osteoporosis are multiple myeloma and other monoclonal gammopathies, lymphoma, leukemia, mastocytosis, hemophilia,, sickle disease and thalassemia.
Several inherited or genetic disorders have been linked to osteoporosis. These include osteogenesis, imperfecta, Multicentric carpotarsal osteolysis syndrome, Multicentric osteolysis, Nodulosis, and arthropathy. Marfan syndrome, hemochromatosis, hypophosphatasia, (for which it is often misdiagnosed),
People with scoliosis of unknown cause also have a higher risk of osteoporosis. Bone loss can be a feature of complex regional pain syndrome. It is also more frequent in people with Parkinson's disease and chronic obstructive pulmonary disease.
People with Parkinson's disease have a higher risk of broken bones. This is related to poor balance and poor bone density. In Parkinson's disease there may be a link between the loss of dopaminergic neurons and altered calcium metabolism (and iron metabolism) causing a stiffening of the skeleton and kyphosis.

Medication

Certain medications have been associated with an increase in osteoporosis risk; only glucocorticosteroids and anticonvulsants are classically associated, but evidence is emerging with regard to other drugs.
Steroid induced osteoporosis (SIOP) arises due to use of glucocorticoids – analogous to  Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug  prednisone is a main candidate after prolonged intake. Some professional guidelines recommend prophylaxis in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months. It is recommended to use calcium or Vitamin D as prevention.  Alternate day use may not prevent this complication.
Barbiturates phenytoin and some other enzyme-inducing  antiepileptics – these probably accelerate the metabolism of vitamin D.
L-Thyroxine over-replacement may contribute to osteoporosis, in a similar fashion as thyrotoxicosis does. This can be relevant in subclinical hypothyroidism.
Several drugs induce hypogonadism, for example aromatase inhibitors used in breast cancer, methotrexate and other antimetabolite drugs,  depo progesterone and gonadotropin releasing hormone agonists.
Anticoagulants – long-term use of heparin is associated with a decrease in bone density, and warfarin (and related coumarins) have been linked with an increased risk in osteoporotic fracture in long-term use.
Proton pump inhibitor – these drugs inhibit the production of stomach acid ; this is thought to interfere with calcium absorption. Chronic phosphate binding may also occur with aluminum -containing antacids.
Thiazolidinediones (used for diabetes) – rosiglitazone and possibly pioglitazone, inhibitors of PPARy, have been linked with an increased risk of osteoporosis and fracture.
Chronic lithium therapy has been associated with osteoporosis.

Differential Diagnosis

Costocondritis

Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions. Over-the-counter nonsteroidal anti-inflammatory drugs
Occurs on the left side of your breastbone, Is sharp, aching or pressure-like, Affects more than one rib, Worsens when you take a deep breath or cough.
While there is no laboratory or imaging test to confirm a diagnosis of costochondritis
Treatment : Stretching exercises and Pain relievers. Ask your doctor about using ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others). Heat or ice. Try placing hot compresses or a heating pad on the painful area several times a day. Rest.

Lifestyle

Plenty of sunshine. Sunlight is the best source of vitamin D. There should be half an hour sunlight exposure every day for strong bones.
Nutritious diet with calcium supplement at least 1 gram daily.
Before 21 years of age take good care of your bones
Keep your digestive system healthy
One should eat slowly and chew the food extremely well
The essential vitamin-D directly influences the absorption of calcium and phosphorus compounds from the intestine.
Measuring 400 I U of Vitamin D is recommended.
A cup of milk daily helps in meeting the calcium requirement of the body and thus helps in building strong bones.
One boiled egg a day also can lead to strong bones in a growing child.
Low stress/ proper breathing/ spend time outdoor;
Bisphosphonate medications are useful to decrease future broken bones in those with previous broken bones due to osteoporosis.
Routine like head rotation/ shoulder movement/ movement of other joints
Removal of carpets or other items facilitating falls.
Wear well fitted footwears.
Proper diet during childhood.
Modify habits (laced shoes, illuminate house at night, install railings, non-skid tiles in bathroom).
Removal of obstacles and loose carpets in the living environment may substantially reduce falls.
Avoid spilling water on floor while mopping the floor.
In people with coeliac disease adherence to gluten free diet decreases the risk of osteoporosis and increase bone density.
Efforts to avoid medications that increases the rate of bone loss.
Exercise daily : Walking + light weight. There is some evidence that physical exercise may be beneficial for bone density in postmenopausal women and lead to a slightly reduced risk of a bone fracture.
A increased bone activity and weight-bearing exercises at a young age prevent bone fragility in adults.
No Tobacco smoking.
Abstinence from alcohol,
Fall prevention can help prevent osteoporosis complications
Plenty of sunshine. Sunlight is the best source of vitamin D. There should be half an hour sunlight exposure every day for strong bones.

Exposure to sunlight

For Senior Citizens :

* 51 % of senior citizens fall down while climbing stairs. Every year citizens are killed by falling while climbing the stairs.

Expert reminder -

* After 60 years these 10 actions should be avoided:

* Do not climb stairs. If you climb, hold on firmly to Staircase railing.

* Do not rapidly twist your head. Warm up your whole body first.

* Do not bend your body to touch your toe. Warm up your whole body first.

* Do not walk backwards. Falling backwards can result in serious injury.

* Do not bend waist to lift heavy weight. Bend your knees and lift up heavy object while half squatting.

* Do not get up fast from bed. Wait a few minutes before getting up from bed.

* Do not over use force in the wash room. let it come naturally..

* You must be active always and think positive. life has started now of all years of hard work. Now its time to enjoy life, take it easy.

* Do not stand to wear your trousers. Wear your pants while sitting down.

* Do not sit up when lying face up. Sit up from one side (left hand side or right hand side) of your body.

* Do not twist your body before exercise. Warm up whole body first.

For Senior Citizens

To to all the elderly (60-100 years and above.

I don't advocate the determination of bone density anymore, because the elderly will definitely have osteoporosis and with the increase of age, the degree of osteoporosis will definitely become more and more serious and the risk of fracture is bound to get bigger.

There is a formula:

The risk of fracture= external damage force/ bone density.

The elderly are prone to fractures because the denominator value (bone density) is getting smaller and smaller, so the risk of fractures will definitely increase.

Therefore, the most important measure for the elderly to prevent fractures is to do everything possible to prevent accidental injuries.

How to reduce accidental damage?

There are the twelve characters of the so-called secret that I summed up, which is:

“Be careful, be careful, be careful again"!

Specific measures include:

1. Never stand on a chair or stool to get something, even a low stool.

2. Try not to go out on rainy days.

3. Take special care when bathing or using the toilet, to prevent slipping.

4. The most important, especially for women - dont wear underwear in bathroom, taking support of wall or other things... The commonest cause of slipping and fracture of hip joint... After bath, come back to your changing room.. Sit comfortably on either a chair or on your bed and then put on underwear.

5. While going to toilet, ensure that bathroom floor is dry and not slippery. Use only comod, but at the same time fix a hand rest to hold it while getting upright from the comod sit. same is true while taking a bath sitting on bath stool.

6. Be sure to clean up the floor in the house before going to bed, and take double care when floor is wet.

7. When getting up in the middle of the night, sit on the bed for 3-4 minutes, be sure to turn on the light first, and then get up.

8. At least in night or even during day time (if feasible), please, please do not close toilet door from inside. If possible have an alarm bell fitted in toilet n press it alarm family members in case of any emergency.

9. Seniors must sit on a chair or a bed and wear pants.

10. In the event of a fall, you must stretch out your hands to support the ground. It is better to fracture the forearm and wrist than to fracture the femoral neck at the hip joint.

11. I strongly advocate exercise, at least walk, to the extent possible for you.

12. Especially for women. be very, very serious to keep your weight in permissible limits. Diet control is the most important key. Eating leftovers, common behavior of women, just get away from it. Feed leftovers to stray cows, keeping your weight in control is absolutely in your had and your mind, "always better to stop eating with half stomach full, rather than eat till have a satiety for having full stomach.

Regarding increasing bone mass, I also advocate dietary supplements (dairy products, soy products and seafood, especially small shrimp skins, which are high in calcium) rather than medicinal supplements.

The other is to do outdoor activities properly, because sun exposure (under UV light) converts the cholesterol in the skin into vitamin D.

It is beneficial to promote intestinal absorption of calcium and osteoblast activity has the effect of delaying osteoporosis.

2. Elderly health care:

A fall may not necessarily lead to a fracture, but the vibration and impact force of the fall will make the whole body function of the elderly in a state of disintegration, the meridians and collaterals are blocked and they cannot become an organic whole to achieve self-balancing regulation, resulting in rapid failure of the functions of the viscera, and thus rapid death.

Pay special attention to the non-slip of the bathroom. When going up the stairs, pay attention to the handrails and don't fall. Everyone, take care.

Therefore, the elderly must pay attention to anti-skid and anti-fall.

One fall will cost ten years of life. Because all the bones and muscles are destroyed. Surgery is useless, and conservative treatment is also a drag. So, be careful.

Avoid standing for too long

The message may look long, but it’s worth reading it especially for the seniors and those taking care of seniors.

Yoga

Surya Namaskar

● Squat or Garland Pose Malasana (मलासना )


Squatting is one of the most effective ways to tone the entire lower body. As the pelvis descends it encourages the downward flowing energy of Apana Vayu and thus helps in constipation.
To learn to squat or if you are pregnant: Separate your feet about 6 to 8 inches, and place a folded blanket under your heels until you are able to lower your pelvis and maintain balance.

Benefit :
This asana strengthens abdominal and pelvic muscles, increases blood circulation and aids in digestion.

"However, one need not become slave of one's desire."

Squatting


Mountain Pose / Tadasana: (ताड़ासन )

Awareness on synchronization of breath with body movement, maintaining balance and stretch of the whole body.
Benefit :
It strengthens knee, thigh and ankle.
Strengthens the body
Relaxes the muscles
Improves the posture
Enhances body flexibility
Increases height in formative years.
Boost mental awareness
Promotes weight loss.
Boosts Energy Levels.
Improves Your Mood.
Provides Relief From Sciatica.

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● Tree Pose Vrikshasana ( वृक्षासन )

Technique : Duration 20-30 seconds. Need to stand firmly and in a symmetrical fashion. Look straight ahead. Now make the thoracic spine straight pull the shoulder blades back and raise the arms. Press the palms together while stretching the arms and elbows as far as possible. Make sure not to slump in front due to the weight of the arms.

Benefit :

Improves balance and stability in the legs.
On a metaphysical level, helps one to achieve balance in other aspects of life.
Strengthens the ligaments and tendon of the feet.
Strengthens and tones the entire standing leg, up to the buttocks.
Assists the body in establishing pelvic stability.

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● Plough Pose Halasana (हल आसन)

Look straight ahead

3- Now make the thoracic spine straight pull the shoulder blades back and raise the arms.

4- Press the palms together while stretching the arms and elbows as far as possible.

5- Make sure not to slump in front due to the weight of the arms.

Triangle pose Trikonasana ( त्रिकोणासन )

: In this, stand back to a wall and separate the feet. Now walk the left foot about a couple of inches, while maintaining your balance. Now, stretch the arms horizontally while turning the right foot perpendicular to the left. Maintain the arm in an outstretched position and breathe for about half a minute. Straightened up and do the same for opposite side.
Benefit :

Stretches and strengthens the thighs, knees, and ankles.
Stretches the hips, groins, hamstrings, and calves; shoulders, chest, and spine.
Stimulates the abdominal organs.
Helps relieve stress.
Improves digestion.
Helps relieve the symptoms of menopause.

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Warrior Pose Virabhadrasana ( वीरभद्रासन )

Technique : Stand with your legs three to four feet apart and turn your right foot slightly to the right, and your left foot 90 degrees to the left. Align your left heel with your right heel. Expand your arms out stretching them parallel to the floor, with your palms facing down. As you exhale, bend your left knee, bringing your left thigh as parallel to the floor as Is comfortable for you. Keep expanding your arms away from your body keeping the torso long and the shoulders entered over your pelvis. Press your outer right heel into the floor and focus on firming the right leg as you bend the left knee .Do not allow your back to "sway" out instead, keep the tailbone tilted slightly towards the pelvis. This asana strengthens the legs and knee muscles and improves balance. This pose helps sciatica, rheumatism and osteoarthritis of knee and hip. It strengthens the legs and also makes them more flexible.
Benefit:

Strengthens your shoulders, arms, legs, ankles and back.
Opens yours hips, chest and lungs.
Improves focus, balance and stability.
Encourages good circulation and respiration.
Stretches your arms, legs, shoulders, neck, belly, groins and ankles.
Energizes the entire body.

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● The camel pose Ustrasana ( उष्ट्रासन )

When working from home , we often tend to slouch more than we would be in an office setting. Hence, in order to straighten your spine, you can practice Ustrasana. Repeat it 3-4 times.
Benefit :
Reduces fat on thighs.
Opens up the hips, stretching deep hip flexors.
Stretches and strengthens the shoulders and back.
Expands the abdominal region, improving digestion and elimination.
Improves posture.
Opens the chest, improving respiration.
Loosens up the vertebrae.
Relieves lower back pain.
Relieves stress on your neck muscle but also helps to make your back supple.

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Eagle Pose Garudasana ( गरुड़ासन )

Technique : In Sanskrit Garuda means kidneys. First stand straight and then bring left leg forward over the right leg and now coil left leg over right leg. Then in similar manner coil both the hands together and both palms should touch each other in a position of Namaskar. Hold it for some times and then repeat its steps with another side of the body.

Benefit :

Stronger arms legs, knees and ankles.
Open shoulder joints, creating space between the shoulder blades'
Open hips and IT band
Increased circulation to all joints.
Improved digestion and elimination.
Improved balance
Improved focus.

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●   Dogs Pose Adho Mukha Svanasana (अधो मुख स्वानासन )

Technique : Come down on all fours. Keep your back extremely straight. Come into your fours. Form a table such that your back forms a table top and your hands and feet form the legs of the table. As you breathe out to lift the hips up, straightening the knees and elbows, form an inverted V–shape with the body. Hands are shoulder width apart, feet are hip width apart and parallel to each other, toes point straight ahead. Press your hands into the ground wide through the shoulder blades. Keep the neck lengthened by touching the ears to the inner arms. Hold the downward dog pose and take long deep breaths. Look towards the naval. Exhale bends the knees, return to table pose, Relax.

Benefits

Calms the brain and helps relieve stress and mild depression.
Energizes the body.
Stretches the shoulders, hamstrings, calves, arches, and hands.
Strengthens the arms and legs.
Helps relieve the symptoms of menopause.
Relieves menstrual discomfort when done with head supported.
Helps prevent osteoporosis

Wheel Pose Chakrasana (चक्र आसन ) Back Bend

How to do it?

Step 1: Lie down on the back.
Step 2: Inhale and place the palms on the floor beside the head with the fingers pointing towards the shoulders, and the knees bent and heels touching the buttocks.
Step 3: Retain the breath and then slowly lift the trunk from the floor.
Step 4: With normal breathing, slowly lift the back and the trunk and give weight to the palm.
Step 5: Create an arch with normal breathing and hold the final position for as long as comfortable.
Step 6: At the last step, Exhale and slowly lower the body so the head rests on the floor and then lower the rest of the body.

Benefit :

Good for first chakra.
An inter medial yoga pose that open in front of all the Chakras.
Stretches the chest and lungs.
Strengthens the arms and wrists, legs, buttocks, abdomen, and spine.
Stimulates the thyroid and pituitary.
Increases energy and counteracts depression.
Therapeutic for asthma, back pain, infertility, and osteoporosis.

Contra-indication

1) People who have weak wrist or unable to support the whole body by their arms should refrain from doing this.
2) People suffering from frequent headaches and migraine should avoid doing it.
3) People suffering from spinal ailments like cervical and lumbar spondylitis should not do this.
4) It is not supportable to the people who have stomach ulcers, heart problems and High Blood Pressure.
5) If anyone feeling dizziness then it should not be done.
6) It is not recommended to a diabetic patient.
7) People having acidity should avoid Chakrasana.

"Go natural. Take care of your body. It will pay you back rich dividends when you need it most."

Bhujangasana (Cobra pose)

● Cobra pose Bhujangasana (भुजंगासना )

Technique : Lie down on your abdomen by taking legs apart. Keep the palm beside the chest. Breathing in, lift the upper part of your body, up to naval region. Hold it for 10 seconds by feeling the stretch on your abdomen. Repeat this for 3-4 times.

Benefit :

The posture is a panacea for an injured spine and in cases if slight displacement of spinal discs.
The practice of this pose replace the discs in their original position
The spinal region is fully toned and the chest fully expanded.
This asana is beneficial in diabetes, bronchitis, asthma and spondylitis.
This asana is very useful in relieving stiffness in upper back and also boost flexibility in lower back while strengthening our core muscles
Opens up the shoulders and neck.
Tones the abdomen.
Strengthens the entire back and shoulders.
Improves flexibility of the upper and middle back.
Expands the chest.
Improves blood circulation.
Reduces fatigue and stress.
Useful for people with respiratory disorders such as asthma. (Do not practice this yoga pose during the attack though).
Flexibility of the dorsal spine, strengthens the spinal muscles. Prevent back pain. Reduces abdominal fat.

Caution: Pregnant women and people with slip disc should avoid this asana.

"Calcium keeps your bone strong, skin hair, teeth and nails healthy".

Pranayama

Anolom Vilom Alternate nostril breathing- This is a calming and powerful pranayama
Kapalabhati (Skull Shining breathing technique)- Normal inspiration and forceful expiration.
Omkar Meditation- Chanting “OM” is a powerful way to control your nerves. It can be practiced at bedtime.
Bhramari (Bee breathing)- The vibrations generated by this bee breath pranayama resonate within a deeply relaxing body and mind.

Exercises

Weight-bearing endurance exercise and / or exercises to strengthen muscles improve bone strength in those with osteoporosis.

Sit To Stand Maneuver

Sit up tall in a sturdy chair (that won't slide) with your feet shoulder wide apart ; move forward to the front of the chair ; place your feet so that your heels are slightly behind your knees. Hinge forward from the hips, keeping the spine long, and place your hands on your thighs, stand up, putting equal weight through both legs. Sit down by hinging at the hips and lowering your self with control. Keep up your chest throughout the exercise. Repeat 10 times. To further challenge yourself, you can place your arm across your chest or use a shorter chair or hold light weight in your hands while doing the exercise.

Why

Resistance exercise like this one strengthens the muscles and bones. "When you are contracting your muscles you're pulling on the bone which stimulates bone growth. That's why resistance exercise are particularly good for bone health and for preventing of managing osteoporosis.

Aerobics, weight bearing, and resistance exercises all maintain or increase BMD in postmenopausal women. .

Skipping

“Regular physical exercise for the prevention and treatment of osteoporosis”

Weight-bearing exercises like sitting on the chair without chair/ running/ jumping/ lifting/ jogging

Best exercise for osteoporosis

Best Bone Strengthening workout

Resistance Exercises

Playing outdoor games/climbing staircase
Walking for half an hour daily
Cycling, swimming, dancing
Spinal extension exercises
Physical exercise and maintenance of muscular strength in the elderly (walking, swimming)

“Running keeps osteoporosis at bay”

Exposure to Sunlight

Mudra

Akash Mudra

Formation- Formed by joining together the tips of the thumb and the middle finger.

Benefit- This Mudra is beneficial for any bone-related diseases, as the calcium content within the body increases.

Benefit :

This mudra is beneficial in any bone related disease, as the calcium content within the body increases.
This mudra removes tooth problems and makes the teeth strong.

Prithvi Mudra

Formation- Join the tip of the ring finger with the tip of the thumb.

Benefit- Osteoporosis, Osteomalacia , diminished bone density and rickets can be cured.

Marma

Manibandha Marma- It is located at the wrist joint, holding the wrist of one hand with the middle finger and thumb of another hand on the dorsal side stimulates it. Then rotate your hand in clockwise and anti-clockwise direction. It should be done for 15-18 times.
Kukundara marma It is located at the back, where the pelvic girdle and the vertebral column meet, at the region of a belt, two in number. Stimulation- Sit in vajrasana or sukhasana, keep your hand over belt line with the help of thumb press sacroiliac joint 15-18 times.
Katika taruna marma It is situated at the back at the location of sciatic notch. Stimulation- Sit in vajrasana buttocks resting on the heels.

Chakra

Muladhara chakra

It is a root chakra, located at the base of the spine. Concentration on this chakra strengthen the bones.

“Liberal use of pineapple is considered beneficial in the prevention of osteoporosis and bone fractures”.

Diet

Pineapple

Dietary sources of calcium include dairy products, leafy greens, legumes, and beans

milk

Beans

Legumes

Edamame : Edamame is a Japanese dish prepared with immature soybeans in the pod. The pods are boiled or steamed and may be served with salt or other condiments. The dish has become popular across the world because it is rich in vitamins, dietary fiber, and isoflavones.

Edamame are young soybeans harvested before they have ripened or hardened. They are nutrient-rich and may offer a range of health benefits. Managing Pre Menopause- Consumption of Edamame is linked to a premenopausal symptoms including hot flushes, fatigue, irritablity, and night sweats because
of natural levels of phytoestrogens. Specially eaten in Japan.

Young Soyabeans

Banana, kiwi, orange & blue berry.

Vitamin D and Calcium rich in foods for healthy bones: Fresh fruit salad :

Drumstick leaves : Moringa (Drumstick) has much more calcium found in milk which builds strong bones and teeth. It helps prevents osteoporosis.

Drumstick leaves/ Moringa oleifera

Eat wholesome food
Dairy products : milk, ghee, buttermilk, yogurt, are ideal for building bone tissue.
Home made cottage cheese
Ground Nuts- 100 gm / day
Oat Dalia, bajra khichri, bajra roti
Sesame seed (til)- laddoo, rewadi, chatani, chikki
Sunflower seeds are excellent food for osteoporosis
Jaggery- 50 gms/ day and Kala Chana
Fenugreek- seeds, laddoo, vegetable
Sprouts moong, moth (mataki)
Mixed grain bread, Missi roti
Salad Beetroot, carrot, celery, cabbage
Soup tomato, meat, ragi, vegetable, moong dal
Betal leaves, curry leaves
Supari (Areca catechu) 10 gms per week
Egg- 1 per day (yolk), vitamin D supplement
Fish- 200 GMs /day
Mushrooms- 150 gms / month
Raw juices fruits and vegetable orange, lemon pineapple, Papaya green leafy vegetables beetroot, carrot
Soybeans in form of soya milk, tofu
Eating 1 tsp Amla powder daily, Amla Murabba, Chyawanprash, Amla candy
Cereals like oat, bajra, wheat
Roasted flax seed and till tsp daily
Almond, plum, figs
Vegetables such as green leafy vegetables, snake gourd, broccoli, garlic, parwal, Chauli (Amaranthus ) turnips, cabbage, tomato, ridge gourd
Drumstick leaves (8-10), flower and fruit
Fruits such as guava, strawberries, avocado, pomegranate, grapes
Pith and flower of plantain (banana)
Seafood such as salmon and sardines
Conch shell
Millet such as ragi, Quinoa Asparagus
Pulses : Dilochus biflorus or horse gram is known as (kulath dal) in Hindi. Its high in calcium, iron and proteins.

A Vegetarian Diet : Spicy preparations
a) Nutritious Roti - Ground flour of raw bananas, Soozi ( Rava) , rice flour + cumin seeds+ garlic + chilly ; little salt should be served with home made butter.
b) Nutritious Dosa Rice flour, gram flour, Shingada flour (water chestnut) Methi, buttermilk, chilly , salt. Make dosa of this flour and serve hot with chutney of fresh coconut.
c) Puri Wheat flour, gram flour, soozi, chilly, salt. Fry this in ghee.
d) Solakari ( Sour soup of Vrikshmla) Crush fresh coconut and prepare coconut milk. add Kokum juice (Garcinia indica) black pepper ,saindhav salt and chilly.
f) Tomato soup Make a soup of coconut milk and tomato puree.
g) Upma Make upma of Dalia ( prepared from wheat)
g) Gram soup Make a soup of gram flour, grated coconut, Owa, ( ajwain) and salt. As gram ,wheat ; coconut are nutritious and avoid the degenerative changes.
f) Kulath Dal Pulses : Dilochus biflorus or horse gram is known as (kulath dal) in Hindi. Its high in calcium, iron and proteins.

Sweet Preparations :
1 Laddu Dink Laddu: Laddu prepared from "Gum acacia" , the nutritious resin.
2 Shira Shira prepared from Badam, green gram, Banana and fresh coconut.
3 Kheer a Wheat flour, coconut, dry fruits b) Rice Kheer c) Rice prepared from Shingada flour.
4 Sweet Uttappa a) Rice Uttappa - Uttappa made up from Rice flour, milk, sugar, mango juice processed in ghee. b) Wheat Uttappa - Wheat flour , milk and sugar.
5 Petha The sweet made up from Ash gourd (Benincasa cerifera). Other sweets prepared from coconut and milk.
6 Fruits Fresh fruits like Jack fruit, mango ,and banana.
7 Vegetables Vegetables of Raw Banana and raw Jack fruit.
B Non Vegetarian Diet
Paya Soup Bone soup
Nali Shorba Mogalai soup - Bone soup.
Nali Nahari Mutton soup.
Mutton Paya.
Egg Omlette processed in ghee.

“Maintain an ideal body weight for healthy bones”.

Avoid

Late meals and overeating
Avoid corticosteroid, chronic use of steroids is associated with secondary osteoporosis and fractures.
Avoid tea, coffee, white sugar, white flour products
Processed refined denatured food
Smoking, alcohol
Avoid the diet which increases Vayu.

Herbs

Ginger
Long pepper
Cinnamon
Phytoestrogens herbs used to help postmenopausal women Alfalfa, parsley, sage, aniseed, fennel, liquorice
Incompatible diet - Food like consumption of milk and fish together.
Excessive use if salty, spicy and hot food.
Excessive use of fermented food like bread.
Food with Preservatives.
Food which is alkaline and penetrating.
Stale and dry food.

Home Remedies

Pop a handful of sesame seeds (til) seeds every morning, an effective home remedy for osteoporosis, sesame seeds provides 1,000 mg of natural calcium in a handful (til laddoo).
Almond milk is another good home remedy to cure osteoporosis, it is a rich source of calcium which is required for healthy bones. You can easily make it at home by soaking almonds in warm water, peeling, grinding and mixing with milk.
Another cure for osteoporosis is consuming soy products. Since imbalance of hormone results in bone loss, soy product helps in balancing the estrogen level required for women suffering from osteoporosis.
Manganese is a vital mineral for treating osteoporosis according to the latest studies. Manganese rich food such as pineapple, spinach, beans, nuts and whole wheat in the diet.
A little bit of ragi added to wheat flour of chapattis daily can do wonders for the bones in just a few months.

Ragi

Drumstick

Bone Broth : It contain high amount of collagen, which is ideal for cell growth. Also it is high on protein and low on calories, making it ideal for weight loss. Bone broth keeps one satiated for long, keep the body hydrated and improves skin and hairs and nails too,

"Be Strong And Stay Beautiful"

Treatment

The management of osteoporosis aims to prevent bone fracture through a reduction in bone loss. Various therapeutic agents should be considered for the management of osteoporosis. This generally includes the administration of Bisphosphonates, Raloxifene, Teriparatide, and Denosumab. Bisphosphonates possess antiresorptive properties and are considered first-line pharmacologic therapy for the management of postmenopausal osteoporosis.

1 . Bisphosphonates

Sodium alendronate 10mg/d or 70mg once a week.
Risedronate 5mg/dose or 30mg once a week
Ibandronate 150mg once a month

2 . Teriparatide Bonista

If patient cannot tolerate bisphosphonates or mostly used in patients with established osteoporosis 250 mcg/ml, injection once daily.

3 . Strontium ranelate

2g oral suspension daily.

4 . Hormone replacement

In Hypogonadal men :Testosterone.
In female : Estrogen replacement therapy e. g. .clomiphene, ofimoxifene.

5 . Calcium

1,000 mg of calcium for those aged 19–50, and 1,200 mg for those aged 50 and above.

6 . Vitamin D3

Capsules or sachets 1,000 IU once a week for 8 weeks ,than one daily.

7 . Ibandronate (Vebalone)

Oral or IV. In Post Menopausal osteoporosis. Dose once monthly oral and quarterly IV. Once monthly dose is associated with good safety and tolerability.

8 . Zoledronic acid (Zoldria)

Every three to four weeks 4 mg infusion.
Miacalcic nasal spray : One puff daily for 3-6 weeks, gives good pain relief for spinal compression osteoporotic fracture.

9 . Protein food supplements

1 tablespoon thrice a day (may be mixed with milk or a beverage}.

Advise

Spinal extension exercises.
Use of spinal support.
High protein diet.
To refrain from bending the back and lifting weight.
Avoid Corticosteroid drugs
Non weight bearing crutch walking.

Steroid Osteoporosis

Calcitriol 0.5 mg daily prevents loss of bones in patient starting treatment with steroids.
Calcium by mouth.
Estrogen replacement in pos menopausal women.
Calcitonin nasal spray one puff daily for one month.

For Fracture

800 IU per day Vitamin D supplement

Calcium. (an increased risk of myocardial infarctions, kidney stones, and stomach problems is associated with calcium supplementation. 1,000 mg of calcium for those aged 19–50, and 1,200 mg for those aged 50 and above.

Physiotherapy, Exercises
Vitamins & Calcium supplement- Calcium 1.5 to 2 grams per day
Vitamin D3 Vitamin D is commonly known as the “sunshine vitamin.” That’s because your skin makes vitamin D when it is exposed to sunlight

If calcium malabsorption cholecalciferol 0.25 mg (10,000) IU

Estrogen therapy for small thin women or early menopause

Calcitonin also inhibits bone reabsorption and has been shown to prevent menopausal bone loss.

Bisphosphate inhibit bone reabsorption
Sodium fluoride stimulates osteoblasts and new bone formation
Estrogen replacement in postmenopausal women

Physiotherapy

People with osteoporosis are at higher risk of falls due to poor postural control, muscle weakness, and overall deconditioning. Postural control is important to maintaining functional movements such as walking and standing. Physical therapy may be an effective way to address postural weakness that may result from vertebral fractures, which are common in people with osteoporosis. Physical therapy treatment plans for people with vertebral fractures include balance training, postural correction, trunk and lower extremity muscle strengthening exercises, and moderate-intensity aerobic physical activity. The goal of these interventions are to regain normal spine curvatures, increase spine stability, and improve functional performance. Physical therapy interventions were also designed to slow the rate of bone loss through home exercise programs.

Hip Protectors

Hip protectors

Hip protectors decrease the number of hip fractures among the elderly. They are cost effective More modern hip protectors do not suffer from these disadvantages because they are slimmer with a low profile, so less noticeable, have ventilation holes and ducting to keep the skin cool under the pad and are soft and pliable conforming to the contours of the hip. Types : Hip protectors are either of the "crash helmet type" or "energy-absorbing type". The "crash helmet type" distributes impacts into the surrounding soft tissue, while the "energy-absorbing type" is made of a compressible material and diminishes the force of impact. Both of these systems aim to reduce the focused force beneath an estimated fracture threshold.

Ayurveda

Abhyanga Massage with Sesame or til / mustard oil daily for strengthening the bones
Panchkarma treatment that involves snehana (oleation), swedana (sudation), and mild purifying therapies
Intake of foods, which are of sweet, sour and salt taste
Gandha tailam- taken orally as well as for local application
Asthisamharaka :A Panacea for bone health. Name : Cissus quadrangilaris, hadjod, (joining bone) devil's backbone, or adamant creeper or bone vine, miracle healer. Vajra balli, Mangara balli, Pirandai, KandvelIt is a potential and effective bone builder supplement. In pregnancy it is consumed for bone health. Tablets are made from it. used for joint injury, broken bone care and healing ligament properties. It is used for fixing bone fracture. Stem paste mixing with egg albumin and applied on the affected part. By boiling its leaves and stems, a curry is prepared to consume, which is believed to cure osteoarthritis.
It has hot potency which alleviates Vata and kapha dosha. It posses dry light and mild laxative attributes. It is an appetizer, digestant, an aphrodisiac and a bone healer. Uses : Rich in calcium, it is advised to use during pregnancy, child birth and for weakness due to menopause ( or menorrhagia)To treat bone fractures, the crushed stems are used as a poultice over bone fracture, A medicated ghee is prepared and administered orally. To get rid of obesity, diabetes, heart problem, cancer and in metabolic syndrome. Asthisamharaka is also prescribed as a general tonic.

“Be kind to your bones, and they will treat you right”

* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.

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