Osteoporosis is a disease that weakens bones, and if you have it, you are at a greater risk for sudden and unexpected bone fractures.Osteoporosis develops when bone density decreases. The body reabsorbs more bone tissue and produces less to replace it. The disease often develops without any symptoms or pain, and it is usually not discovered until the weakened bones cause painful fractures. Most of these are fractures of the hip, wrist and spine.
After age 50, one in two women and one in four men will have an osteoporosis-related fracture in their lifetimes. Another 30% have low bone density that puts them at risk of developing osteoporosis. This condition is called osteopenia.
There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:
• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected
Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you’re young, your body makes new bone faster than it breaks down old bone and your bone mass increases. After the early 20s this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it’s created.
How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. Peak bone mass is partly inherited and varies also by ethnic group. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.
Risk Factors –
There are many risk factors that increase your chance of developing osteoporosis which includes-
Women over the age of 50 or postmenopausal women have the greatest risk of developing osteoporosis. Women undergo rapid bone loss in the first 10 years after entering menopause, because menopause slows the production of estrogen, a hormone that protects against excessive bone loss.
Age and osteoporosis affect men also. You might be surprised to know that men over the age of 50 are more likely to have an osteoporosis-induced bone break than to get prostate cancer.
Caucasian and Asian women are more likely to develop osteoporosis. However, African-American and Hispanic women are still at risk.
• Family History
If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may have a greater risk of developing the disease.
• Bone structure and body weight
Petite and thin people have a greater risk of developing osteoporosis because they have less bone to lose than people with more body weight and larger frames.
• Some medical conditions and medications
If you have or had any of the following conditions, some of which are related to irregular hormone levels, you and your healthcare provider might consider earlier screening for osteoporosis.
• Overactive thyroid, parathyroid, or adrenal glands.
• History of bariatric (weight loss) surgery or organ transplant.
• Hormone treatment for breast or prostate cancer or a history of missed periods.
• Celiac disease, or inflammatory bowel disease.
• Blood diseases such as multiple myeloma.
Some medications cause side effects that may damage bone and lead to osteoporosis. These include steroids, treatments for breast cancer, and medications for treating seizures.
• Eating habits
You are more likely to develop osteoporosis if your body doesn’t have enough calcium and vitamin D. Although eating disorders like bulimia or anorexia are risk factors, they can be treated.
People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis.
• Tobacco use
Smoking increases the risk of fractures.
• Alcohol use
Having two drinks a day (or more) increases the risk of osteoporosis.
Bone fractures, particularly in the spine or hip, are the most serious complications of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury.
In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine (vertebrae) can weaken to the point of collapsing, which can result in back pain, lost height and a hunched forward posture.
If your doctor suspect osteoporosis, they will request a bone mineral density scan (BMD).
Bone density scanning uses a type of X-ray known as dual-energy X-ray absorptiometry (DEXA).
DEXA can indicate the risk of osteoporotic fractures. It can also help monitor a person’s response to treatment.
Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If your risk isn’t high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.
For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:
• Alendronate (Binosto, Fosamax)
• Ibandronate (Boniva)
• Risedronate (Actonel, Atelvia)
• Zoledronic acid (Reclast, Zometa)
Compared with bisphosphonates, denosumab (Prolia, Xgeva) produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months.
▪︎ Hormone-related therapy
Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of breast cancer and blood clots, which can cause strokes. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.
Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug can reduce the risk of some types of breast cancer.
In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone.
▪︎ Bone-building medications
If you have severe osteoporosis or if the more common treatments for osteoporosis don’t work well enough, your doctor might suggest trying:
• Teriparatide (Bonsity, Forteo)
• Abaloparatide (Tymlos)
• Romosozumab (Evenity)
Ayurvedic Perspective –
Ayurveda this depletion of the bone tissue is called ‘Asthikshaya’ and occurs due to two main mechanisms.
• The first is deficiency of nutrients suitable for nourishing the bone because of malnutrition and/or the catabolic activity of Vata dosha.
• The second is blockage of the channels/pathways responsible for conveying this nutrition to the bone tissue (known as srotarodha), usually as a result of imbalanced digestion (Agni) and the formation of Ama.
It can also occur due to a combination of both.
Ayurvedic approach to osteoporosis will involve detoxification and balancing the doshas, especially vata dosha, using panchakarma, an ancient Ayurvedic detoxification process.
The panchakarma treatment consists of –
• Internal oleation (taking ghee or flaxseed oil to prepare the doshas and impurities to be removed from the tissues)
• Snehana (massage)
• Bashpa swedana (sweating)
• Kati basti (medicated oils and herbal preparations introduced into the rectum for the purpose of flushing toxins from the intestinal tract)
• Shiro dhara (warm herbal oil is poured in a thin steady stream through a spicket directly onto the forehead and sixth chakra)
followed by purging to remove all the vitiated doshas from the body systems.
Food supplements and rejuvenators such as shatavari (Asparagus racemosus), ashwagandha (Withania somnifera) and bala (Sida cordifolia), amalaki (Emblica officinalis) should be taken in the powdered form in the dose of 2–3g daily.
Amalaki is an Ayurvedic medicine for the bones, nourishing them, strengthening the teeth and causing hair and nails to grow. Five grams of powder in one cup of water twice a day is used as a general tonic. Triphala can be used on regular basis as a tridoshic tonic.
Certain alterations to lifestyle can reduce the risk of osteoporosis.
▪︎ Calcium and vitamin D intake
Calcium is essential for bones. People should make sure they consume enough calcium daily.
Dietary sources include:
• dairy foods, such as milk, cheese, and yogurt
• green leafy vegetables, such as kale and broccoli
• fish with soft bones, such as tinned salmon and tuna
• fortified breakfast cereals
If a person’s calcium intake is inadequate, supplements are an option.
Vitamin D also plays a key role in preventing osteoporosis as it helps the body absorb calcium. Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from sun exposure, so doctors recommend moderate, regular exposure to sunlight.
▪︎ Lifestyle factors
Other ways to minimize the risk are:
• avoiding smoking, as this can reduce the growth of new bone and decrease estrogen levels in women
• limiting alcohol intake to encourage healthy bones and prevent falls
• getting regular weight bearing exercise, such as walking, as this promotes healthy bones and strengthens their support from muscles
• exercises to promote flexibility and balance, such as yoga, which can reduce the risk of falls and fractures
For people who already have osteoporosis, nutrition, exercise, and fall prevention techniques play a key role in reducing the risk of fracture.
▪︎ Fall prevention
Tips for fall prevention include:
• removing trip hazards, such as throw rugs and clutter
• having regular vision screenings and keeping eyewear up to date
• installing grab bars, for example, in the bathroom
• ensuring there is plenty of light in the home
• practicing exercise that helps with balance, such as tai chi
• asking the doctor to review medications, to reduce the risk of dizziness
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