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LowBoneDensityCauses,AyurvedicTreatment,Diet
ByDrRaghuramY.S.MD(Ay)
Bonescanbreakduetoinjury,fall,accidents.Butdidyouknowthatyourbonescanbreakjustlikethat!!Ifthat
happensthenitmeansthatyouhaveweakandbrittlebones.Itmeansthatyourboneshavelessmineralthan
needed.ItmeansthatyouhaveaconditioncalledOsteopenialowbonedensity.

Allthosewhohaveosteopeniaarepronetobonefracture.
Thetrickypartismanyofyouwillnotevenbeawarethatyouhaveosteopeniauntilyouwouldhavefractured
yourbone.
Mostimportantpartofthisconditionisthatitdevelopsinasilentwayandgivesnoclueofitspresenceinthe
formofsomepainfulsymptoms
ButitisimportantthatallofusknowaboutOsteopeniabecauseitgivesusanadvantagetotackleitbeforeit
manifestsandruinsourbones!

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WhatisOsteopenia?
Osteopeniaisaconditioninwhichyourbonedensityislowerthannormalpeakdensity.Itleadstobone
weakeningandanincreasedriskofbreakingabone(fracture).Butthedensityisnotlowenoughtobeclassified
asOsteoporosis.
Morespecifically,itisdefinedasabonemineraldensityTscorebetween1.0and2.5

Note:

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Bonedensity:Itisameasurementofyourbonestodeterminehowdenseandstrongyourbonesare?
OsteopeniaisariskfactorandpredisposestoanotherconditioncalledOsteoporosis.
OsteoporosisisanadvancedconditionofOsteopeniainwhichthebonedensityisevenlow,muchlesser
thaninOsteopenia.

Howtopreventlowbonedensity?
AsperAyurvedatohavegoodbonehealth,oneshouldconsumegoodamountsofoils(sesameoil,oliveoil)and
ghee.
Oilmassage,atleastonceaweekwithsesameoilorAyurvedicoilssuchasMahanarayanaoilishighly
recommended.
Consumecalciumsources:
Calciumisthemostimportantmineralforthemaintenanceofbonemass.Thebestsourcesofcalciumare
Milkandotherdairyproducts
Greenvegetables
Calciumenrichedproducts
CalciumsupplementsCalciumtabletsoftencombinedwithVitaminDareprescribedinosteopenia.
VitaminD:
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Ithelpsyourbodytoabsorbcalciumandotherminerals
Itisfoundineggs,salmon,sardines,swordfishandsomefishoils
Itisaddedtomilkandcanbetakenincalciumandvitaminsupplements
BodymakesnaturalvitaminDwhenitisexposedtosunlight

Exercise:
Itisimportantforhavingstrongbones.Boneformsinthebodyinresponsefromstress.Weightbearing
exerciseswhichcausestressonboneslikewalking,hikinganddancingareallgoodchoices.Addingexercise
withlightweightsorelasticbandscanhelpthebonesintheupperbody.Talktoyourdoctororaphysical
therapistaboutstartinganexerciseprogramme.
Quitsmoking
Avoidexcessiveuseofalcoholandbeverageslikecola
Howtomaximisebonedensity?
SuntimeSpendsometimewalkingorjogginginthesun,earlyinthemorning
IncludeCalciumandvitaminDindiet
ExerciseGetintoweightbearingexercisesregularly
Dontsmoke
Avoidcola
Avoidexcessivealcohol
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Guidekidstodothesame,allowthemtoplayinlittleinthesunshinetohelptheirbodiesmakemore
vitaminD.
Ifyouareolderthan30years,
RememberItsnevertoolate
Youcanstillslowdownthelossofbonedensity,delayosteopeniaandosteoporosisbypracticinga
balanceddietandregularexercises
Plantoestrogens:Goodforwomenespeciallyforthosearoundmenopause
Soybean
Lentils
Chickpeas
Beans

GoodfoodsforBones:
Eatingrightfoodscangiveyoumaximumbonestrengthandboostyourbonedensityatanyage
Milk
Milkistherichsourceofcalcium.Itissaidtobepopstarofcalciumsources.Asingle8ouncecupofmilk
(skimorlowfatorwhole)suppliesyouaservingof300mgofcalcium.
Calciumrequirement:
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Adultsuptoage50upto1,000mg/day
Beginningatage51womenneeds1,200mg/day(menatandfrom71yearsofage)
YoghurtandCheese
Acupofyoghurthasatleastasmuchcalciumasan8ouncecupofmilk
1ounceofSwisscheesehasthesamequantityofcalcium
Itisgoodforeventhosehavinglactoseintoleranceandthosewhodontdrinkmilk
Lactosefreedairyproducts(removinglactosefrommilkanddairyfoodsdoesnotaffectcalciumcontent)
Sardines(Smallfattyfishusuallycanned)3ouncesofcannedsardinesgivesyoualittlemorecalciumthana
cupofmilk
Greens:
Darkleafygreenshaverichcalcium
Bokchoy,ChinesecabbageandKalearethebestsourcesofcalcium
Collardandturnipgreensofferalotofcalcium
1cupofchopped,cookedturnipgreenshasabout200mgcalcium
Fortifiedfoods(addingmicronutrientstothefood):
Theydonotnaturallycontaincalciumbuthavebeenenhancedwithvaryingamountsoftheessential
mineral.
Breakfastfoodsareagreatstart
Fortifiedorangejuicehasthesameamountofcalciumasmilk.
Fortifiedcerealsprovideupto1,000mgs/cup.
Oatmeal
1packetoffortifiedoatmealprovides1000mgofcalciuminmostadults.Similarbenefitsareobtainedby
takingacupofcalciumfortifiedorangejuice,cupofyoghurtandcupofcookedspinach
SoyFood:
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Calciumenrichedtofu(1/2cup)containsover400mgsofcalcium
Soymilkisusuallyfortifiedwith300mgsofcalcium/cup
ResearchPlantbasedchemicalscalledIsoflavonesstrengthenbones.Theyareplentifulinsoyfoods,
suchastofu.Soyisusefulinwardingoffbonediseaseinpostmenopausalwomen.
Salmon:
Salmonandotherfattyfishesofferbulkofboneboostingandstrengtheningnutrients.Theycontain
vitaminD.Theyarealsorichinomega3fattyacids.Theseconstituentshelpbones.Fishoilsupplements
reducebonelossinwomenandmayhelpinpreventingosteoporosis.
NutsandSeeds:
Walnutsandflaxseedsarepackedwithomega3fattyacids.
Peanutsandalmondscontainpotassiumwhichprotectsagainstthelossofcalciuminurine
Nutsalsocontainproteinandothernutrientsthatplayasupportiveroleinbuildingstrongbones
Hazelnuts
RestrictSalt:
Saltdeprivesthecalciumcontentsofthebody.
Themoresaltyoueat,themorecalciumgetscarriedawayfromyoururine.
Sticktoalowsaltdiet.Thiswillhelpconservecalciuminyourbodyandstrengthenyourbones.
Otherfoods:
Wholegrains
Broccoli
Brussels
Cabbage
Sprouts
Beans
Blackgram
Chickpeas
Greengram
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Seaweeds
Honey
Others:
SunShine:
BodyproducesvitaminDinresponsetosunlight.
WithoutvitaminD,ourbodiescannotproperlyabsorbthecalciuminourfoods.
InterferingfactorsCloudyweather,northernlatitudeanddarkerskin
RecommendeddietaryintakeofvitaminDis600IUformostadults(over800IUabove70yearsofage)
Weightbearingexercises:
Regularweightbearingexerciseswillhelpyoutogetmostofyourboneboostingdiet.
Thisincludesanyactivitythatusestheweightofyourbodyoroutsideweightstostressthebonesand
muscles
Asaresultofthisthebodylaysdownmorebonematerial,yourbonebecomesstronger
Briskwalking,dancing,tennisandYogabenefityourbones
Calciumsupplements:
Shouldbeconsideredifyoudontgetenoughcalciumfromyourdiet
Takenomorethan500mgsatonetime(takedoctorsopinion)
Supplementslikecalciumcarbonatearebetterabsorbediftakenwithfoodcalciumcitratecanbetaken
anytime
Note:Ifyougetenoughcalciumfromfood,takingpillstoocanincreasesideeffectsofexcesscalciumlike
kidneystonesetc.
Tryathome:
Dandeliontea
Almondmilk(soakalmondsinwaterandthenaddtheminmilkorsoyamilk)
Dairyproducts,mainlymilk
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Plentyofsoyproducts
Eatmorepineapples,spinach,wholewheatandbeans
Eatchasteberry
1teaspoonofhoneyeveryday
Handfulofsesameseedsearlyinthemorning
Greentea
HowmuchvitaminDandcalciumdoweneed?
Ref:InstituteofMedicine
http://www.webmd.com/osteoporosis/features/areyougettingenoughvitamindcalcium
VitaminD
Adultsofagegroup1970yearsofage600IU/day
Adultsolderthan70yearsofage800IU/day
Calcium
Dailyrequirementvarieswithageandgender:
Newbornsto6months200mg
Babies712months260mg
Kids,13years700mg
Kids,48years1,000mg
Kidsandteens,918years1,300mg
Adults,1950years1,000mg
Adultmen,5170years1,000mg
Adultwomen,5170years1,200mg
Alladults,71yearsandolder1,200mg
Pregnant/Breastfeedingwomen1,000mg
Pregnantteens1,300mg
OtherfoodswhichhavevitaminDare:
Salmonsandsardines,eggyolks,Tuna,Mackerel,Shrimp,Mushrooms
FoodswithaddedvitaminD,suchasmilk,cereals,yogurtsandorangejuices
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Codandfishliveroils
ShouldIgetmyVitaminDbloodtestdone?
SomedoctorsprefercheckingvitaminDlevels,somedont.
IfyouareconcernedthatyoumightberunninglowvitaminD,youcanaskyourdoctortogetyourblood
valueschecked
Peoplewithcertainhealthconditionslikeinflammatoryboweldiseaseareatahigherriskforhaving
vitaminD
Thosewhodontgooutofhome(outdoors)much,havedarkerskin,donttakesupplementsanddonteat
foodsrichinvitaminDareatahigherriskforhavinglowvitaminD
YourdoctormayprescribesupplementsifyourbloodshowslowlevelofvitaminD
Followup:
RepeatBMD,usuallyafter2yearstodetectprogressivebonelossanddetermineiftreatmentisneeded
(whenmedicationhasnotbeenstarted)
AfollowuptestforBMDisfrequentlyrepeatedaftertreatmentwithprescriptionisbegun.
Topicscoveredinthisarticle:
Whyisosteopeniaimportant?
WhatcausesOsteopenia?
Diagnosis
DifferentialDiagnosis
AyurvedicconceptsofOsteopenia
AyurvedicTreatmentplan

Whyisosteopeniaimportant?
Osteopeniaisimportantbecauseitcancausebonefractures
Peoplewithosteopeniaarenotaslikelytofractureaboneasthosewithosteoporosis
Butincomparisontoosteoporosis,therearemanypeoplewithosteopenia.Obviouslypatientswith
osteopeniaaccountforalargenumberofpatientswhofractureabone.
RememberPeoplewithosteoporosishavegreaterriskoffracturingabonethanthosewithosteopenia
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Bonefracturesduetoosteopeniaandosteoporosisareimportantbecausetheycanbeverypainfulalthough
somespinal(vertebral)fracturesarepainless
Hipfracturesnotonlycausepainbutalsorequiresurgicalrepair
Manypatientsrequirealongtermnursinghomecareafterahipfracture.Fracturesinelderlyare
associatedwithanincreaseinoverallmortality(deathrate).Manypeopledieinashortperiodfollowing
hipfractureduetocomplicationsincludingbloodclotsrelatedtoimmobility,pneumoniaandmanyother
reasons.

WhatcausesOsteopenia?
Calciumisabsorbedintothebodyandinsomecircumstances,bonelosessomepartofcalciumfromit(called
bonereabsorption).
Aspeoplegrowolder,thebonesnaturallybecomethinner.Thechangesstarttohappeninmiddleageitself.
Thereshouldalwaysbeabalancebetweenboneformationandbonereabsorptionbythebodywhichisquiet
normalbeforeweattainmiddleage,i.e.duringactivegrowth.Aftermiddleage,themoreoftheexistingbone
cellsarereabsorbedbythebodyincomparisontothenewbonebeingmade.Thismeanstotellthatasweage
further,theboneformationwillbecomelessincomparisontobonereabsorption.
Asthisoccurs,thebonesloseminerals,heaviness(mass)andstructure(shapeandsize).Thisfurthermakesthe
bonesweaker.Thisalsoincreasestheirriskofbreaking.
Allofusreachthepeakbonedensityatabout30yearsofage.Afterthispeoplebeginlosingbonemass.The
thickeryourbonesareataboutage30,thelongerittakestodeveloposteopeniaand/orosteoporosis.
Osteopeniamaybearesultofoneormoreotherconditions,diseaseprocessesortreatments.
Causes:
Osteopeniaoccursmorefrequentlyinpostmenopausalwomenduetolossofoestrogen
Womenaremorelikelytodeveloposteopeniaandosteoporosisthanmen.
Thereasonisthat:
Womenhavealowerpeakbonedensity
Hormonalchangesduringmenopausespeedsupthelossofbonemass

Otherimportantcausesforosteopenia:
Genetics(familydispositiontoosteopeniaand/orosteoporosis,familyhistoryofearlybonesandother
geneticdisorders)
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Hormonal(decreasedoestrogenasinwomenaftermenopauseortestosteroneinmen)
Eatingdisordersandmetabolismproblemsthatdonotallowthebodytotakeinanduseenough
mineralsandvitamins
Chemotherapyorcertainmedicines(ex.corticosteroidsandantiseizuremedications)
Malabsorptionduetoconditionslikeceliacsprue
ChronicinflammationduetomedicalconditionssuchasRheumatoidarthritis
Exposuretoradiation
Beingthin(Thinframeofbody)
BeingwhiteorAsian
Limitedorlessphysicalactivity(Immobility)
Smoking
Excessivebeveragedrinks
Excessivealcohol
Exacerbatingfactors:
Lackofexercise
Excessconsumptionofalcohol
Smoking
Prolongeduseofglucocorticoidmedications
Exposuretoradiation
Morefrequentlyin
Participantsinnonweightbearingsportslikebicyclingorswimmingthaninweightbearingsportslike
running
Theconditionisoftennotedinyoungfemaleathletes.Itisoneofthe3majorcomponentsoffemale
athletetriadsyndromealongwithamenorrhoeaanddisorderedeating.Femaleathletestendtohavelower
bodyweight,lowerfatpercentageandhigherincidenceofasthmathantheirlessactivepeers.Achronic
energybalancecansuppressoestrogenlevelsanddecreasebonemineraldensity
Itisalsoasignofageing,incontrasttoosteoporosiswhichispresentinpathologicageing
Osteopeniaisalsoacommoneffectofceliacdisease
SymptomsofOsteopenia:
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Osteopeniahasnosymptoms
Evenasthebonebecomesthinnerandstartlosingdensityyoumaynotnoticepainoranyotherchanges
Theriskofbreakingaboneincreasesasthebonebecomeslessdense

Diagnosis
OsteopeniaisdiagnosedwithaBoneDensityTest
DualenergyXrayabsorpimetry(DXA)
Itisthemostaccuratetestofbonedensity
ItisaformofXraywhichdetectsaslittleas2%ofbonelossperyear
ADXAscanmeasuresBonemineraldensity(BMD)inthehip,spineandsometimeswrists.Theselocationsare
chosenbecausethesearefrequentsitesofbonefracture.
StandardXrayisnotdiagnosticofosteopenia(notsensitivetodetectsmallamountsofbonelossorminor
changesinbonedensity)
USPSTF(UnitedStatesPreventiveServicesTaskForce)recommendsthatallwomenaround65yearsofage
andoldershouldhaveabonedensitytesttoscreenforosteoporosis.Itrecommendsthatyouandyourdoctor
checkfractureriskusingatoolsuchasFRAX.FRAXwillhelptodecidewhetheryoushouldbescreenedfor
osteoporosis.
FRAXtoolwasdevelopedbytheWorldHealthOrganization(WHO)topredictyourriskofhavingafracture
relatedtoosteoporosisinthenext10years.
Othertests:
PeripheralXrayabsorptiometry(pDXA)
Quantitativecomputedtomography(QCT)
PeripheralQCT(pQCT)
Quantitativeultrasounddensitometry(QUS)
Howtodo?
YoutoocanuseFRAX
Gotothewebsiteatsheffield.ac.uk/FRAX
ClickonCalculationTool
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Thiswillhelpyouifyouhavehadabonedensitytestonyourhip
Ifyouhaveundergonethistest,typeinyourscore
Ifyouhavenotundergonethetest,leavethescoreblank
Whoshouldbetestedforosteopenia?
EveryonedoesntneedtoundergoaBoneMineralDensitytest.Yourdoctoristherightpersontodecideifyou
needtoundergothetestafterapreliminarysetoftestsandexaminations.TheNationalOsteoporosisFoundation
recommendsthefollowinggroupsofpeoplebetestedforosteopenia(orosteoporosis):
Women65yearsandoldermen70yearsandolder
Postmenopausalwomenandmen5069yearsofageatincreasedriskofosteoporosis
Adultswhohaveabonefractureafterage50
Adultswithamedicalconditionassociatedwithboneloss(suchasrheumatoidarthritis)orwhotakea
medicationwhichcancauseboneloss(prednisoneorothersteroids)
Anyonebeingconsideredforprescriptiontreatmentforosteopeniaorosteoporosis
Anyonebeingtreatedforosteoporosistomonitortreatment
RiskFactors:
Beingwhite(Caucasian)oranAsian
FamilyhistoryofOsteoporosis
Beingthin
Longtermuseof
Corticosteroids,suchashydrocortisoneorprednisoloneforinflammatoryconditions
Anticonvulsantssuchascarbamazepine,gabapentin
Phenytoinforpainorseizures
Eatingdisordersordiseasesthataffecttheabsorptionofnutrientsfromfood
Beinginactiveorbedriddenforalongerdurationoftime
Smoking
Drinkingexcessivealcohol
HavingadietlowincalciumorvitaminD
Menwithlowlevelsoftestosteronealsoareatariskofdevelopingosteopenia
Allopathictreatemtforlowbonedensity:
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Treatmentshouldaimattakingstepstopreventosteopeniafromprogressingtowardsosteoporosis
Treatmentofosteopeniaincludes
Lifestylechangesthatcanhelpreduceboneloss
Medicinesfordiagnosedosteopenia
Therapyrecommendations(medicines)
https://en.wikipedia.org/wiki/Osteopenia
TargetgroupThoseathighestriskofosteoporoticbonefracturebasedonBMDandclinicalriskfactors
Asof2008recommendationsfromNationalOsteoporosisFoundation(NOF)arebasedonriskassessments
fromWHOFractureRiskAssessmentTool(FRAX).Accordingtotheserecommendations,therapyshouldbe
consideredforpostmenopausalwomenandmenolderthan50yearsofageifanyoneofthefollowingispresent:
1.Priorhiporvertebralfracture
2.Tscoreof2.5atthefemoralneckorspine,excludingsecondarycauses
3.Tscorebetween1.0and2.5atthefemoralneckorspineanda10yearprobabilityofhipfracture20%
4.Cliniciansjudgementincombinationwithpatientpreferenceindicatestreatmentforpeoplewith10year
fracturepossibilitiesaboveorbelowtheselevels.
(Notablythefirst2conditionsidentifyindividualswithosteoporosis.The3rdconditioncorrespondsto
individualswithosteopenia,namelythosewithTscorebetween1.0and2.5)
Prognosis
Bonelosscanbeslowedorstabilizedwithlifestylechangesormedicationifnecessary.
Insomesituations,bonelossmaycontinueduetohormonalfactors,medicalconditionsormedications.
Ex.untreatedceliacsprue,untreatedorresistantrheumatoidarthritisandtreatmentwithsteroidmedication
suchasprednisoneusedforanothermedicalcondition
Prevention:
Thebelowsaidthingsdeterminethatyouhaveatendencytodeveloposteopenia
Familyhistoryofosteopeniaorosteoporosis
Takingsteroidsforchronicasthma
QuantityofcalciumandvitaminDwhichyouhavetaken(foryourdeficiencies)whileyouweregrowing
up
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Thereisnothingmuchyoucandoaboutit
Youcandevelopstrongbonesandhelpslowdownosteopeniaandpreventosteoporosisbytakingappropriate
measuresif:
Youareayoungadult
Youareraisingchildren
Bestbefore30:
Anymeasurestakentoincreasebonedensityandpreventosteopeniaandosteoporosiswillhavelongterm
benefitsiftheyarebroughtintopracticebeforeyouhaveachieved30yearsofage.Thisisbecauseyour
bonesdontreachtheirgreatestdensityuntilyouareabout30yearsofage.Thereforepreventivemeasures
bestfittochildrenandyoungstersbelow30yearsofage.

DifferentialDiagnosis:
Osteoporosis
CauseReductioninbonemassdensity,advancedandprogressedconditionofosteopenia
Symptoms:
Backache
Graduallossofheightandanaccompanyingstoopedposture
Fracturesofthespine,wristorhip
Osteomalacia
CauseVitaminDdeficiencyleadingtosofteningofyourbones.Softbonesaremorelikelytobowand
fracturethanareharderandhealthybones.
Symptoms:
Muscleweakness
Achybonepain(mostcommoninlowerback,pelvis,hips,legsandribs.Painmaybeworseatnightor
whenyouareputtingweightontheaffectedbones.
Decreasedmuscletoneandlegweaknessmaycauseawaddlinggaitandmakeitdifficultforyoutoget
around
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Hyperparathyroidism
Causeparathyroidglandsinyourneckproducetoomuchparathyroidhormone(PTH).Thishormonecontrols
calcium,phosphorus,andvitaminDlevelsinthebloodandbone.
Whencalciumlevelsaretoolow,thebodyrespondsbymakingmoreparathyroidhormone.Thishormone
causescalciumlevelsinthebloodtorise,asmorecalciumistakenfromtheboneandreabsorbedbythe
intestinesandkidney.
Inthisconditionthereisabnormallyhighconcentrationofparathyroidhormoneinthebloodresultingin
weakeningofthebonesthroughlossofcalcium
Symptoms:
Bonepainortenderness
Depressionandforgetfulness
Tirednessandweakness
Fragilebonesofthelimbsandspinethatcanbreakeasily
Increasedamountofurineproducedandneedtourinatemoreoften
Kidneystones
Nausea
Lossofappetiteetc
Multiplemyeloma
CauseItisacancerthatformsinatypeofwhitebloodcellcalledaplasmacell.Plasmacellshelpyoufight
infectionsbymakingantibodiesthatrecognizeandattackgerms.MMcausescancercellstoaccumulateinthe
bonemarrowwheretheycrowdaroundhealthybloodcells.
Symptoms:
Bonepain,especiallyinyourchestorspine
Nausea,Constipation,Lossofappetite
Excessivethirst
Weaknessornumbnessinlegs,Weightloss
Frequentinfections
Fatigue,Confusion
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BonemetastasisorSkeletalmetastases(metastaticbonedisease)
CauseCancermetastasesthatresultsfromprimarytumourinvasiontothebone
Symptoms:
Severepain(dullachewhichworsenswithtime),worseatnight
Bonefractures,Spinalcordcompression
Hypercalcaemia,Anaemia
Spinalinstability,Decreasedmobility
Leukaemia
Causeamalignantprogressivediseaseinwhichthebonemarrowandotherbloodformingorgansproduce
increasednumbersofimmatureorabnormalleucocytes.Thesesuppresstheproductionofnormalbloodcells,
leadingtoanaemiaandothersymptoms
Symptoms:
Newlumporswollenglandinyourneck,underyourarmorinyourgroin
Frequentnosebleeds,bleedingfromgumsorrectum,orheavymenstruation
Frequentfevers,Nightsweats
Bonepain
Lossofappetite,Weightloss
Tirednesswithoutaknownreasonetc
Rickets
CauseExtremeandprolongedvitaminDdeficiencyleadingtosofteningandweakeningofbonesinchildren
Symptoms:
Delayedgrowth
Paininthespine,pelvisandlegs
Muscleweakness
Skeletaldeformitieslikebowedlegs,thickenedwristsandankles,breastboneprojectionetc
Scurvy:
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CausedeficiencyofvitaminC
Symptoms
Malaise,Lethargy
Painingumswhichinterfereswithdigestion
Shortnessofbreath
Bonepain
Myalgia(musclepain)
Skinchangesroughness,easybruising,petechiae
Looseningofteeth
Drymouth,Dryeyesetc
Anaemia
Cause:deficiencyofredcellsorofhaemoglobinintheblood
Symptoms
Pallor,Fatigue
Weakness,Generalmalaise
Poorconcentration
Dyspnoea(shortnessofbreath),Palpitationsetc
Cushingsyndrome
CauseAbnormallyhighlevelsofahormonecalledcortisol
Symptoms
Roundshapedface(moonface)
Afattyhumpinbetweenyourshoulders(buffalohump)
Upperbodyweightgain
Skinthatbruiseseasily
Pinkorpurplestretchmarksonyourskin
Highbloodpressure,Diabetes
Boneloss,leadingtofractures
Decreasedlibidoandfertility
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Fatigue,Muscleweaknessetc
http://www.medicinenet.com/osteopenia/page7.htm

AyurvedicconceptsofOsteopenia
Aswithanydisease,wecannotmakeanexactcorrelationofosteopeniatoanydiseaseconditionexplainedin
Ayurveda.Butweshalltrytodrawahypothesisaboutthediseaseandpossibilitiesoftreatment.
SinceOsteopenia(&osteoporosis)isaconditionofboneswhichlosedensityandpresentsnosymptoms,we
shalltrytofinditsAyurvediccounterpartwhichhassimilarfeatures.
Osteopeniaisrelatedtotheformation,maintenanceandnutritivepartofthebone.Thuswewilltouch
theAyurvedicaspectinthatperspective.
ConceptofboneformationinAyurveda:
AccordingtoAyurveda,AsthiDhatu(Bonetissue)isaPitrujaAvayava(Paternaltissue).
(EmbryologicalconceptAllhardtissuesororgansinachildaresaidtobederivedfromfather)
DhatuPoshanaKrama(Chronologyoftissueformationandnutrition):
DhatusortissuesareformedinachronologicalorderaccordingtoAyurveda.Theyareformedinaninter
relatedandinterlockedchainmechanismandalsonourisheachother(successivetissues).
Theformationandnutritionavailabletoeachtissuetoformitscomponentsinaregularandhealthyway
dependsonhowbesttheprevioustissueisnourishedandenrichedfromtheessenceofnutritionprovidedfrom
thegut(&itsprecursordhatu).
Inthiscontext:AsthidhatuisthenextdhatutobeformedafterMedadhatu(fattissue/adiposetissue)anda
precursorofMajjaDhatu(bonemarrow).
Thatmeanstotellthat
MedadhatuleadstotheformationofAsthiDhatuand
AsthiDhatuleadstotheformationofMajjaDhatu.
TheprecursorsofAsthiDhatuare:
MedadhatuFatoradiposetissue(immediateprecursor)
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MamsadhatuFleshormusculartissue(precursorofMedadhatu)
RaktadhatuBloodtissue(precursorofMamsadhatu)
RasadhatuLymphorplasma(precursorofRaktadhatuandaproductofAhararasaoressenceoffood
suppliedfromthegut)
ThesuccessorsofAsthiDhatuare:
MajjadhatuBonemarrow(immediatesuccessorofMedadhatu)
ShukradhatuSemenorreproductivetissue(successorofMajjadhatu)
OjusEssenceofalltheabovesaidtissueswhichrepresentsthestrength,immunityandlifespanofeach
andeverycell
ThusfortheAsthidhatuorbonetissuetobeformedinahealthy,qualitativeandquantitativewayits
precursordhatusshouldhaveformedproperly.
IfthereisapathologicalincreaseordepletionoftheAsthidhatuprecursors,theboneformationand
maintenancetakesabeating.Themetabolismofbonetissuebecomesdisturbedleadingtolossofdensity,
brittleness,osteopeniawhichfurthermightprogresstoosteoporosis.
SimilarlyifthereisapathologicalincreaseordepletionofAsthidhatu(anditsprecursors)itwillhavea
disturbingimpactontheformationandmaintenanceofthesuccessivedhatus.
AsthiDhatuKshaya:
AsthiDhatuKshaya(Depletionofbonetissue)canbealiketermwhichcanbeusedincomparisonto
Osteopenia.Thedecreaseordepletionofbonetissuecanbetakenasreductioninbonedensity.Thishappens
dueto:
Agnivikriti:(metabolicdisturbances)
AlmostallthemetabolicdiseasestakeplaceduetothedisturbancesinAgni(basiccoremetabolismormetabolic
fireinthegut).WhentheAgniisdepleted(Agnimandhyahypofunctionalagni),itleadstoAjeerna
(indigestion)andthefoodisnotdigestedproperly.Asaresult,Amaorintermediateproductsofdigestionis
formedwhichfurtherdeterioratestheagnileadingtoblockageofchannelscarryingthenutrition.Thereis
inadequatenutritionornutritiveessence(ahararasa)goingtothetissueswhenthishappens.Thetissuesrare
notformedproportionally(quantitativelyandqualitatively).ThisincludesAsthidhatualso.
AmongmanycausesleadingtoAgnimandhyaapathologicalincreaseofKapha(wateryingredientsofthe
body)isthechiefculprit.ItkeepstheAgnidilutedandhampersitsnormalfunctioning.
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OnthecontraryiftheAgniishigher(Atyagnihyperfunctionalagni)thefoodisburntoutinsteadofgetting
digested.Againthereisnothingleftforthetissues.Thisalsoleadstoqualitativeandquantitativedepletionof
thetissuesincludingtheAsthiDhatu(Bonetissue)
AmongallthecausesleadingtoAtyagniapathologicalincreaseofPitta(Teekshnagni)andVata
(Vishamagni)arethemainculprits.
Medodhatvagnivikriti:
DhatvagnisaresmallfractionsofthemainJatharagni(bellyfire).DhatvagnisarepresentintheDhatus
(tissues)andarespecificforeachtissue.Ex.RasadhatuhasRasadhatvagni,RaktadhatuhasRaktadhatvagni
etc.
Thesetissuefirestakepartintissuemetabolism.Theyconvertthegrossnutrients(providedbyJatharagni)
presentinthecirculationintominute(micro)nutrients.Theseminuteformofnutritionhelpsintissuebuilding
andalsotakepartintheformationofthenexttissueinthesequence.
Dhatvagnivriddhiandkshaya:
Increaseindhatvagnileadstothedepletionoftissue(local)andconsequentialdecreaseofthesuccessivedhatu.
Decreaseindhatvagnileadstoaccumulationofandblocksinthetissue(local)andsubsequentdepletionofthe
successivetissue.
Thishappensduetotheformationofdhatugataama(intermediateproductsoftissuemetabolism)which
decreasesthecellularmetabolismgrosslyandalsoblocksthechannelsthroughwhichthenutritiontothe
successivetissuesiscarried.
InrelationtoMedoDhatvagni:
TheMedodhatvagni(fireinfattissue)digeststhenutritionandmaterialsprovidedtoitbyitsprecursorMamsa
dhatuandconvertabigpartofitintoMedodhatu(localtissue).Theremainingportionisusedinformingthe
successivedhatui.e.Asthidhatu(bonetissue).Heat,energy,wastes(swedasweatinthiscontext)and
upadhatu(subtissue)areformedintheprocess.
WhenMedodhatvagnidecreases,excessmeda(fat)areformed(medovriddhi)i.e.thefattakesallthenutrition
andalmostsendsnothingtotheAsthidhatu.Theamaformedintheprocessblocksthechannelswhichsend
nutritiontothebones.ThisleadstofewernutrientstoAsthidhatuandconsequentlowdensityandosteopenia.
WhenMedodhatvagniincreasesthereisdestructionoffattissue(medokshaya)andsupplyoffewernutrientsto
Asthidhatu.Thisalsoleadstoosteopenia.
AmongthesymptomsofMedodhatuKshayaismentionedSvapanamKatyahawhichmeansweaknessinthe
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hipregion(susceptibilitytofracture).Hipfracturesarecommonamongosteopeniapatients.
AsthiDhatvagniVikriti:
WhenAsthidhatvagnidecreases,thereisexcessformationofAsthidhatu(Asthivriddhi)andwhenAsthi
dhatvagniincreases,thereislessformationofAsthidhatu(Asthikshaya).
AsthiKshayacanbecomparedtoosteopenia(&osteoporosis)
AmongthesymptomsofAsthiKshayaismentionedMajjanisaushiryam.IfMajjaisconsideredasthematrix
ormaterialswhichconstituteandcontributetothedensityofthebone,MajjaSaushiryamindicateslossofbone
density.AsthiKshayacanbethuscomparedtoOsteopeniaandOsteoporosis.
VataandAsthi:
AllDoshashavetheirabodeinoneortheotherDhatu(tissue).VataislocatedinAsthiDhatu.TheVatawhich
hasundergoneapathologicalincreaseduetoVatadisturbingfoodandlifestyleactivitieswilldepletetheAsthi
dhatucausinglowbonedensity,osteopeniaandosteoporosis.WhenVataundergoespathologicaldecrease,it
causesincreaseinAsthidhatu.
ThusVataincrease(Vatavriddhi)canbeconsideredoneofthecausativefactorsleadingtoosteopenia.Inthis
sense,allthosefoodandlifestyleactivitiescontributingtoVatavriddhicanbeconsideredascausativefactorsof
AsthiKshayavisvisosteopenia(osteoporosis).
VataPrakopakaKaranani(CausativefactorsresponsibleforVatavitiation):
VyayamaExcessiveexercises
ApatarpanaFastinginexcess
PrapatanaFall,injury
BhangaFractures
KshayaDepletionoftissues
JaagaratExcessivevigil(awakeningallnight)
VeganamchavidharanatSuppressionofnaturalbodyurges(reflexes)
AtishuchiExcessiveadministrationofcleansingprocedures(Panchakarma)
ShaityadiExcessiveconsumptionofcoldfoodsandactivities
TraasaatFear
RukshaExcessiveconsumptionofdryfoods
KshobhaIrritation
KashayaExcessiveconsumptionofastringentfoods
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TiktaExcessiveconsumptionofbitterfoods
KatuExcessiveconsumptionofpungentfoods
Varighanagamecloudyandrainyseason
ParinateanneAfterthedigestionoffood
AparahneEvening
AmongthecausativefactorsforAsthivahaSrotoDushti(Contaminationofchannelsprovidingnutritionto
bonesandhelpintheirformation)VatalaAharaVihara(Vataincreasingfoodandactivities)hasbeenexplained.
AsthipradoshajaRoga:
AmongthesymptomsofAsthipradoshajaRoga(Diseasesduetocontaminationofbones)Asthibheda
(splittingpain/fracturesinbone?)andAsthiShula(bonepain)havebeenmentioned.
PhakkaRoga
PhakkaorFakkaRogahasbeenexplainedinAyurvedicPaediatricsandiscomparedtoRickets.
AcharyaKashyapatellsthatAchildissaidtobesufferingfromPhakkaRogaifhe/shedoesnotstandon
theirfootorwalkevenafter1yearofage
Phakkarogaissaidtobeof3types:
KsheerajaDrinkingbreastmilkcontaminatedbymorbidKapha
GarbhajaWhenthemotherofthechildquicklyconceivesforonemoretimeshecannotfeedthechild
duetodeficitproductionofbreastmilk.Thechildgetsdebilitateddaybyday.
VyadhijaPhakkaDuetotheafflictionofdiseaseslikefeveretcforaprolongedperiod
Evenaccordingtomodernmedicalscience,Ricketsistakenasadifferentialdiagnosisforosteopenia

AyurvedicTreatmentplan
TreatmentofOsteopeniabyAyurvedicmethodsshouldbedoneonbelowsaidlines:
TreatingAsthiDhatuKshayaonthelinesofAsthipradoshajavikara(Asthiashritaroga)
Panchakarma:Fivecleansingmeasuresorevacuation(detoxification)therapiesexplainedinAyurvedai.e.
VamanaTherapeuticemesis(vomiting)
VirechanaTherapeuticPurgation
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AsthapanaVastiDecoctionenemas
AnuvasanaVastiOilenemas
NasyaNasalinstillationofmedications
Theabovesaidtreatmentsshouldbeadaptedaccordingtotheconditionofthediseaseanddiseased,after
consideringthediseasepathologybyallitsfragments
VastiAmongthese,Vastiissaidtobethebestchoice.VastiisthebesttreatmentforvitiatedVayu.Wehave
seenthatVatavitiationisthechiefculpritinthecausationofosteopenia.Ksheeravasti(Enemaswithmilk
processedwithbitterdrugs)andSnehaVasti(enemaswithgheeprocessedusingbitterdrugs)areveryusefulin
alleviatingvitiatedVayuandmitigatingosteopenia(andosteoporosis)
TiktaKsheeraMilkprocessedwithbitterdrugsshallbeusedtodrinkandalsoforenemas
TiktaGhritaGheeprocessedwithdecoctionofbitterdrugsshallbeusedfordrinkingpurposeandalsofor
enemas
TreatingVayu:
SnehaAdministrationofmedicatedoils/ghee,Massage,oilpouringetc
SwedaSteaming/sudation/sweatingtherapy
MridushodanamEvacuationtreatment(mildcleansingtreatmentslikeVirechanaetc)
SvadubhojanaConsumingsweetfoods
Amlabhojanaconsumingsourfoods
Lavanabhojanaconsumingsaltfoods
UshnabhojanaHotandfreshfoods
AbhyangamMassagewithherbaloils
MardanaTappingthebodywithclosedfistsafterapplicationofvataalleviatingoils
SekaPouringofmedicatedoilsoverthebodyinstreams
PaishtikaMadhyaAlcoholorfermentedproductspreparedwithflours
GoudikaMadhyaAlcoholorfermentedproductspreparedwithjaggery
SnigdhoshnaVastiMedicatedenemaswithoilsandghee,givenlukewarm
DeepanapachanasnehaOilsandgheeprocessedwithdeepana(appetizer)andpachana(digestant)drugs
AvoidingVataprakopakaaharavihara
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AvoidingfoodandlifestyleactivitieswhichaggravateVata(explainedabove)
CorrectionofAgni,AjeernaandAma:
Disturbanceofmetabolism,indigestionandmetabolitesaresaidtobetheinitialculprits(culpritsatthe
foundation)ofosteopenia.
Lossofappetite,indigestionandanysymptomrelatedtoupperorlowergastrointestinaltractpersisting
foralongerdurationshouldnotbetakenlightly.
Theyshouldbecorrectedbyadministrationgheeprocessedwithdeepana(firestimulatingorappetizing)
drugsandpachana(digestionpromotingoramadestroying)drugsorthesamedrugsmixedinghee.
MedicinescanbegiveninotherformsalsoChurna,Kashayam,etc
Ex:ArdhrakaGhrita,GuggulutiktakamGhritam/Kashayam,TiktakaGhritam/Kashayam,PippalyadiGhritam,
IndukantamGhritam,TrikatuChurna,Panchakolachurnaetc.
Thesamemedicationscorrecterrorsofdhatugataagnimandhya(lowtissuemetabolism)andstrengthen
thetissues,themedodhatvagniandasthidhatvagniinthiscase.
Medochikitsa/Medorogachikitsa:
SinceMedaorfatistheimmediateprecursorofAsthidhatu,treatmentandmedicationstopreventor
reduceaccumulationoffatinthebodyshouldbeadministered,especiallyifthepatienthasaweight
puttingtendencyorisobeseandhavingfamilyhistoryofosteoporosisorosteopenia.
Virechana(Therapeuticpurgation),LekhanaVasti(fateliminatingenemas)andUdwarthana(massage
donewithherbalpowdersinthereversedirection)wouldprovidebenefitinthesecases.
Antiobesitymedicationsshouldbegiventoreduceweightandfat.Ex:Medoharavidangadilauha,
NavakaGuggulu,VaradiKashayam,VaranadiKashayam,GuggulutiktakamKashayam
AsthigataVataandSandhigataVatachikitsa
Theabovesaid2conditionsareexplainedinVataVyadhiThoughtheyarepainfulconditionscausedby
vitiatedvayu(paindoesntexistinosteopenia),thetreatmentandmedicinesadaptedinthese2conditions
canalsobeadaptedincaseofosteopeniabecauseallthoseremediestakecareofvitiatedVataanddamage
occurringinthebones.
ThetreatmentsandmedicationsofboththeseconditionsaredoneonthelinesofVataVyadhitreatment
(explainedaboveincontextofTreatVayu)

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TreatingonlinesofBhagnaChikitsa(fracturetreatment):
Inanycaseoffracture,theboneshouldberesetbeforetryinganymedicine.
Generaltreatment:
SekaStreampouringofmedicatedoils,milketc
LepaApplicationofmedicinalpastes
BandhanaBandages
ShetaupacharaColdtreatments(remedies)
Medications:
Asthishrunkala(Cissusquadrangularis)isthebestoptioninfracturesanddislocations
Medicatedgheepreparewiththisdrugistakenorally
Thejuiceoftheplantcanbegivenwithghee
Maceratedstemofthefreshplantisusedforapplicationoverfracture
BabultreeBarkorseedpowderofBabulisgivenwithhoneyforfracturehealing
LashunadiKalkaPasteofequalpartsofGarlic,Lac,honeyandsugarisgivenmixedinghee
PravalaBhasmaPravalaBhasma(ashofcoral)isgivenwithhoneyorghee
ArjunatwakchurnaPowderofbarkofTerminaliaarjunaisgivenwithmilk
ShatadhautaGhrita:Gheeprocessed(washed)withmedicinalherbs(theirdecoctions)for100timesismixed
withShalipishti(riceflour)andappliedoverthefractures
Lakshagodhumadiyoga:Powderoflac,wheatflourandpowderofArjunabark(Terminaliaarjuna)mixed
withghee
Rasonadiyoga:PasteofGarlic,honey,Lac,gheeandsugar
Guggulu(Commiphoramukul)preparations
LakshadiGuggulu
AabhadiGuggulu
TreatingonthelinesofPhakkaRoga:
Ghritapana:(medicatedgheefordrinking)
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KalyanakaGhritam
ShatpalaGhritam
AmrutaGhritam
Shodhana(cleansingmedicines):
AfterthechildissaturatedbySnehana(drinkingmedicatedgheeassaidabove)Shodhana,
especiallyVirechana(purgation)shouldbegivenafter7daysbyadministeringTrivritKsheeramilk
processedwithTrivrit(Operculinaturpethum)
BrahmiGhrita:Aftertheevacuationprocess(Shodhana),BrahmiGhritashouldbegiven
Diet:Mamsayusha(meatsoup),Shali(cookedrice),Siddhaksheera(medicatedmilketc
VastiMedicatedenemas
SvedanaSteamingorfomentationwithherbaldecoctionsormilk
UdvartanaPowdermassagedoneinareversedirection(upward)
Bestformulationsforosteopenia:
MaharasnadiKashayam
DhanwantaramKashayam
Ashwagandharishtam
Dashamoolarishtam
Balarishtam
AabhadiGuggulu
LakshadiGuggulu
TrayodashangaGuggulu
YogarajaGuggulu
MedoharaVidangadiLauha
NavakaGuggulu
VatagajankushaRasa
VatavidhwamsiniRasa
TiktakaGhritam
GuggulutiktakaGhritam
ShatavariGhritam
AshwagandhadiGhritam
MuktashuktiBhasma/MuktashuktipishtiPearlcalcium
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JawarMoharPishti
KamadudhaRasa
MuktaBhasma/Muktapishti
ShringaBhasma
Akikpishti
GandhaTailam
Ksheerabalatailam101
Dhanwantaram101
Importantdrugsusedfortreatingosteopenia:
AsthishrunkalaCissusquadrangularis
AmalakiEmblicaofficinalis
ArjunaTerminaliaarjuna
EquisetumarvenseHorsetail
LakshaLac
GugguluCommiphoramukul
TriphalaFruitsofTerminaliachebula,TerminaliabelliricaandEmblicaofficinalis
PravalaCoral
TilaSesameseeds
BabulVachellianilotica/Acacianilotica
SymphytumofficinaleComfreyroots
AngelicaarchangelicaWildcelery/HolyGhost
ShigruMoringaoleifera(drumstick)
AshokaSaracaindica
AshwagandhaWithaniasomnifera
NagabalaGrewiahirsute
ShatavariAsparagusracemosus
Commonlyuseddrugsfortreatingosteopenia:
Bisphosphonates(alendronate,risedronateandbandronate)
Selectiveoestrogenreceptormodulators(SERMs)suchasraloxifene,oestrogen,calcitoninand
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