OSTEOPOROSIS

• Osteoporosis is an asymptomatic progressive metabolic skeletal disorder. It is characterized by the loss of bone mineral density that leads to decreased bone strength and an increased susceptibility to fractures
• WHO defines osteoporosis as a systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fractures involving the wrist, spine, hip, pelvis, ribs or humerus.
• The disease typically affects postmenopausal women and the elderly, as an abrupt decrease in oestrogen, and age-related processes play a key role in the development of osteoporosis

Primary osteoporosis (most common form)

• Type I (postmenopausal osteoporosis): Oestrogen stimulates osteoblasts and inhibits osteoclasts. The decreased oestrogen levels following menopause lead to increased bone resorption
• Type II (senile osteoporosis): gradual loss of bone mass as patients age (especially > 70 years) 
• Idiopathic juvenile osteoporosis

Secondary osteoporosis

• Drug-induced/iatrogenic: Most commonly due to systemic long-term therapy with corticosteroids, anticonvulsants, L-thyroxine, anticoagulants etc.
• Endocrine: Hypercortisolism, Hypogonadism, Hyperparathyroidism etc.
• Multiple myeloma
• Excessive alcohol consumption
• Immobilization

Risk factors

• Advancing age
• Female
• Menopause
• Previous fragility fracture
• Cigarette smoking
• Malabsorption, malnutrition
• Low body weight
• Family history of osteoporosis
• Low BMI <19 kg/m²

• Mostly asymptomatic until a fracture occurs
• Fragility fractures: pathological fractures that are caused by everyday-activities (e.g. sneezing) or minor trauma (e.g. falling from standing height)
• Vertebral (most common) , femoral neck , distal radius (Colle’s fracture), other long bones (e.g. humerus) are the common locations
• Vertebral compression fractures : Commonly asymptomatic but may cause acute back pain and possible point tenderness without neurological symptoms
• Multiple fractures can lead to decreased height and thoracic kyphosis

Differential diagnosis

• Osteomalacia
• Multiple myeloma
• Hyperparathyroidism

Blood :

• Serum calcium, phosphate, and parathyroid hormone (PTH) levels
• Alkaline phosphatase possibly elevated 

Plain radiography

• Increased radiolucency is detectable in cortical bones
• Osteoporotic vertebral fracture
• Compression fracture

DEXA scan (dual-energy x-ray absorptiometry) :

• Osteoporosis: T-score ≤ -2.5 SD
• Osteopenia: T-score of -1 to -2.5 SD
• Osteoporosis is diagnosed if T-score ≤ -2.5 SD and/or a fragility fracture is present

Quantitative computed tomography (QCT) : measurement of true bone volume density

Adequate amount of calcium and vit D

Internal Medicines

• Maharasnadi kashaya
• Dhanwantara kashaya
• Dhanwantara taila Avarti
• Gandha taila
• Guggulu tiktaka ghrita
• Vidaryadi ghrita
• Satavari guda
• Laksha guggulu
• Abha guggulu
• Sankha bhasma
• Sringa bhasma
• Silajith prayoga
• Ashwagandharishta
• Balarishta

Procedures

• Anuvasana – Dhanwantara taila
• Tikta ksheera vasti