Introduction
Osteoporosis is a familiar term nowadays. We hear this at least once in a day in the form of TV ads, in newspapers or from a colleague who takes that extra Calcium supplement. As you rightly understood, osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Bone is made up of living tissue that is constantly broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women — especially older women who are past menopause — are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.
Signs & symptoms
There will be no symptoms in the early stages of bone loss. But once the bones have been weakened by osteoporosis, signs and symptoms will develop which include:
- Back pain, caused by a fractured or collapsed vertebra
- Loss of height over time due to compression fractures
- A stooped posture
- A bone that breaks much more easily than expected
Causes
Osteoporosis is developed due to depletion in bone tissue, and the supplementing Calcium, Vitamin D3 etc.
Risk factors
Some risk factors for osteoporosis are:
- sex. Women are much more likely to develop osteoporosis than men.
- Age. Old age people are at more risk, especially post-menopausal women.
- Race. Risk is high in white or Asian descent.
- Family history with osteoporosis
- Body frame size. Men and women who have small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.
Hormone levels
Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:
- Sex hormones like oestrogen
- Thyroid problems. Hyperactive thyroid and too much thyroid hormone can cause osteoporosis
- Osteoporosis has also been associated with overactive parathyroid and adrenal glands.
Dietary factors
Osteoporosis is more likely to occur in people who have:
- Low calcium intake
- Eating disorders
- Gastrointestinal surgery
Steroids and other medications used to treat Seizures, Gastric reflux, Cancer, Transplant rejection etc.
Medical conditions
The risk of osteoporosis is higher in people who have certain medical problems, including:
- Celiac disease
- Inflammatory bowel disease
- Kidney or liver disease
- Cancer
- Lupus
- Multiple myeloma
- Rheumatoid arthritis
Lifestyle and habits
- Sedentary lifestyle.
- Excessive alcohol consumption.
- Tobacco use.
Pathophysiology
Multiple pathogenetic mechanisms interact in the development of the osteoporotic state. Understanding the pathogenesis of osteoporosis starts with knowing how bone formation and remodeling occur.
Normal bone formation and remodeling
Bone undergoes both radial and longitudinal growth and is continually remodeled throughout our lives in response to microtrauma. Bone remodeling renews bone strength and mineral, preventing the accumulation of damaged bone. Bone remodeling occurs at discrete sites within the skeleton and proceeds in an orderly fashion, and bone resorption is always followed by bone formation, a phenomenon referred to as coupling.
Dense cortical bone and spongy trabecular or cancellous bone differ in their architecture but are similar in molecular composition. Both types of bone have an extracellular matrix with mineralized and nonmineralized components. The composition and architecture of the extracellular matrix are what imparts mechanical properties to bone. Bone strength is determined by collagenous proteins (tensile strength) and mineralized osteoid (compressive strength). The greater the concentration of calcium, the greater the compressive strength. In adults, approximately 25% of trabecular bone is resorbed and replaced each year, compared with only 3% of cortical bone. Up to 10% of the skeleton is being remodelled at any one time.
Osteoclasts, derived from hematopoietic precursors, are responsible for bone resorption, whereas osteoblasts, from mesenchymal cells, are responsible for bone formation.The 2 types of cells are dependent on each other for production and linked in the process of bone remodeling.
Osteoblasts not only secrete and mineralize osteoid but also appear to control the bone resorption carried out by osteoclasts. Osteocytes, which are terminally differentiated osteoblasts embedded in mineralized bone, direct the timing and location of bone remodeling. In osteoporosis, the coupling mechanism between osteoclasts and osteoblasts is thought to be unable to keep up with the constant microtrauma to trabecular bone. Osteoclasts require weeks to resorb bone, whereas osteoblasts need months to produce new bone and on average bone formation takes 4 to 6 months to be completed. Therefore, any process that increases the rate of bone remodeling results in net bone loss over time.
Alterations in bone formation and resorption
Osteoporosis is multifactorial with an interplay of genetic, intrinsic, exogenous, and lifestyle factors. The hallmark of osteoporosis is a reduction in skeletal mass caused by an imbalance between bone resorption and bone formation. Under physiologic conditions, bone formation and resorption are in a fair balance. A change in either—that is, increased bone resorption or decreased bone formation—may result in osteoporosis.
Osteoporosis can be caused both by a failure to build bone and reach peak bone mass as a young adult and by bone loss later in life. Accelerated bone loss can be affected by hormonal status, as occurs in perimenopausal women; can impact elderly men and women, and can be secondary to various disease states and medications.
Aging and loss of gonadal function are the two most important factors contributing to the development of osteoporosis. Studies have shown that bone loss in women accelerates rapidly in the first years after menopause. The lack of gonadal hormones is thought to up-regulate osteoclast progenitor cells.
Dual energy X-ray absorptiometry, or DXA machine to check bone density
Ultrasound
CT scan
Conventional X rays
Treatments
Treatment for osteoporosis includes medications to help build bone mass. The medications often have hormonal influences, stimulating or acting like oestrogen in the body to encourage bone growth. Examples of medications used to treat osteoporosis include:
- biphosphonates
- calcitonin
- oestrogen
- parathyroid hormone (PTH), such as teriparatide
- parathyroid hormone-related protein, such as abaloparatide
- raloxifene (Evista)
Kyphoplasty is a surgical treatment for fractures.
Bone-building medications are used as a last resort
- Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It’s given by daily injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.
- Abaloparatide (Tymlos) is another drug similar to parathyroid hormone. Used for only two years, which will be followed by another osteoporosis medication.
- Romosozumab (Evenity). This is the newest bone-building medication to treat osteoporosis. It is given as an injection every month. It is limited to one year of treatment, followed by other osteoporosis medications.
Prognosis
The outlook for people with osteoporosis is good, especially if the problem is detected and treated early. Bone density, even in severe osteoporosis, generally can be stabilized or improved. The risk of fractures can be substantially reduced with treatment. People with mild osteoporosis have an excellent outlook.
Complications
- Fractures and deformities
- Compression fracture
- Loss of height
- Stooped posture
- Osteoarthritis
- Heart failure
- Bone cancer
Disease & Ayurveda
Asthidhatu (Bone tissue) in Ayurveda is structurally & functionally inversely proportional to the amount of Vaatadosha. When Vaata is excess due to age or other degenerative conditions, asthidhatukshaya or depletion can take place. This can be understood as osteoporosis and it is actually depletion of bone tissue or asthidhatukshaya.
Nidana
Causative factors for degeneration like old age, poor nourishment etc which leads to Vaatakopa
Kshata (injury)
Purvaaroopa
Not mentioned
Samprapti
When the vitiated Vaata dosha, mainly affects asthidhatu along with dhatvagni (metabolic digestive fire) is vitiated the formation of asthidhatu gets abnormal and produces disease.
Lakshana
Sandhisaidhillya – looseness of joints
Shrama – fatigue
Prapatana of kesa, loma, nakha etc. – Hairfall, brittle nails and teeth etc.
Divisions
Not mentioned
Prognosis
Saadhya in new cases in young people.
Yaapya in chronic cases and old people
Chikithsa
Ayurveda treatment for dhatukshaya starts with aamapaachana (removal of accumulated toxix waste products in the system). Once the aama is removed, medicines are given to enhance and normalise agni (digestive fire). Normal and stable digestive fire means proper digestion, absorption and assimilation. When the asthidhatu is properly nourished, the depletion is cured. According to Ayurveda, asthidhatu is formed from medodhatu (fat tissue). So proper functioning of medodhatu and intake of medicated oils and ghee in proper conditions will be beneficial. Once the dhatwagni and koshthagni are corrected, nourishing therapies are done to nourish the depleted bone tissue.
Samana
Aamappaachana
Agnideepana
Lepana and pradesika dhara with soolaharadravya
Pichu
Upanaha
Sodhana
Sneha-sweda
Kshayavasti
Snehavvasti
Virechana
Commonly used medicines
Rasnerandadi kashayam
Maharasnadi kashayam
Balaatailam sevyam
Dhanwantaram kashayam
Yogaraja guggulu
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
There are no home remedies to cure osteoporosis. But a healthy diet and lifestyle will help in preventing the chance of developing bone spurs.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415937/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
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