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Bone healing

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Related Terms
  • Avulsion fracture, bone fractures, callus, cast, comminuted fracture, compound fracture, compression fracture, computerized tomography, CT, deep vein thrombosis, DVT, first aid, fractures, greenstick facture, hp fracture, magnetic resonance imaging, MRI, non-union of fractures, orthopedic, osteoporosis, pathological fracture, plaster of paris, pulmonary embolism, rib fracture, skeletal system, skull fracture, stress fracture, wrist fracture, X-ray.

Background
  • A fracture or broken bone occurs when a force exerted against a bone is stronger than it can structurally withstand. A bone fracture is a medical condition in which a bone is cracked or broken. While many fractures are the result of high force impact or stress, bone fracture may also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis or certain types of cancer. Bone healing or fracture healing is a process in which the body facilitates the repair of bone fractures.
  • Fractures are among the most common orthopedic (bone-related) problems. About 6.8 million fractures receive medical attention each year in the United States. The average citizen in a developed country can expect to sustain two fractures over the course of their lifetime.
  • Fractures of the extremities (such as arms, wrist, leg, and ankle) are the most common, and usually occur in men younger than age 45, and then become more common in women over age 45. The reason for the difference is that when women go through menopause, and stop producing estrogen, the rate of bone loss increases. Estrogen helps improve bone density. This is why women are particularly susceptible to osteoporosis (a disease causing bones to become thin and brittle) and subsequent fractures. The most common fracture prior to age 75 is a wrist fracture. In those over age 75, hip fractures become the most common broken bone.
  • The skeletal system serves many important functions, including providing shape and form for bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals. The skeletal system is comprised of 206 bones that form a rigid framework. Soft tissues (such as ligaments and tendons) are attached to bones. Vital organs are also protected by the skeletal system. For example, the brain is protected by the surrounding skull and the heart and lungs are encased by the sternum and rib cage.
  • Bones form the skeleton of the body supporting it against gravity allowing a person to move and function in the world. Bone contains the bone marrow, the soft tissue found in the hollow interior of bones. Bone marrow is used in the production of blood cells, such as red and white blood cells.
  • Blood cells are produced by the marrow located in bones. An average of 2.6 million red blood cells is produced each second by the bone marrow to replace those damaged.
  • Bones also serve as a storage area for minerals such as calcium and phosphorus. When an excess is present in the blood, buildup will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply. Excess calcium may result in health conditions such as kidney stones. Excess phosphorus may deplete calcium from the bones and body.

Signs and symptoms
  • The symptoms of a bone fracture depend on the particular bone and the severity of the injury, but may include pain, swelling, bruising, deformity, and inability to use the limb for varying periods of time.

Diagnosis
  • Bone fractures are diagnosed with X-rays. CT (computerized tomography) and MRI (magnetic resonance imaging) scans may also be used. Broken bones heal by themselves; the aim of medical treatment is to make sure the two pieces are lined up correctly. Subsequent X-rays are taken to monitor the bone's healing progress.
  • X-ray: X-rays are low doses of radiation that create an image of a body part, organ, or bodily system on film paper or fluorescent screens. X-rays show the alignment of the spine and may reveal degenerative joint disease, fractures, or tumors.
  • Computed tomography (CT) scan: Computerized tomography (CT) scan is an X-ray that uses computer technology and can be enhanced with the injection of a contrast dye into a vein. CT scans allow for multiple X-rays to be taken from different angles in the body where the pain is located to create a three-dimensional image of internal body structures. CT is used to show abnormalities in bones and soft tissue. CT scan can be used for individuals who are unable to tolerate magnetic resonance imaging (MRI).
  • Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) tests uses a powerful magnet to produce images on a computer screen and film. MRI scans provide clear images of disc deterioration, pathologies of the spinal cord, spinal stenosis, herniated discs, spinal tumors, bone fractures, and abnormalities in nerves and ligaments. MRIs are conducted in a small, confined area and some individuals may find this uncomfortable. Some individuals may have to be sedated using a mild sedative such as alprazolam (Xanax®) or lorazepam (Ativan®). If the individual is sedated, transportation should be organized using a family member or friend.

Complications
  • Every fracture carries the risk of failing to heal and resulting in a non-union, when a bone does not heal. Most non-unions require surgery. Some of the causes of non-union of a bone fracture includes: infection, inadequate blood supply to the bone, and incorrect splinting of the fracture.
  • Blood loss: Bones have a rich blood supply and a bad break can result in substantial blood loss. The circulatory system extends into bones, directly supplying the bone cells and bone marrow. Blood cells are formed within bone marrow. The bone marrow contains special cells called stem cells, which produce the body's red blood cells and platelets. Red blood cells carry oxygen to the body's tissues, and platelets help with blood clotting when a person has a cut or wound.
  • Injuries to organs: Injuries to organs such as the brain (in the case of skull fractures) or chest organs (if a rib breaks) can occur.
  • Infection: Bone infection (osteomyelitis) can occur in an open fracture. The bone may be exposed to fungi and bacteria that cause infection.
  • Growth problems: The fractured long bone of a young child may not grow to its intended adult length if the injury is close to a joint, since bone fuses when it heals. The growth plate is the area of developing tissue near the end of the long bones in children. Each long bone has at least one growth plate at each end. When growth is complete during adolescence, the growth plates are replaced by solid bone. Injuries may occur in children and adolescents. The growth plate is the weakest area of the growing skeleton and a serious injury to a joint is more likely to damage a growth plate than the ligaments around it. An injury that would cause a sprain in an adult can be a potentially serious growth plate injury in a young child.
  • Pain: Bone fractures may cause severe pain. Individuals should stay in close contact with their healthcare providers to ensure that their medications are properly managing the pain. In some cases, the medication or dosage may need to be changed.

Treatment
  • First aid: Suggestions for immediate treatment of a suspected bone fracture include not moving the individual unless there is an immediate danger, especially in the case of a suspected fracture of the skull, spine, ribs, pelvis, or upper leg, due to the chances of nerve damage and signal cord injury or risking further injury to organs and blood vessels. It is best to attend to any bleeding wounds first. Healthcare professionals recommend stopping the bleeding by pressing firmly on the site with a clean dressing. If a bone is protruding, apply pressure around the edges of the wound. If bleeding is controlled, keep the wound covered with a clean dressing. Do not attempt to straighten broken bones. For limb fractures, provide support and comfort such as a pillow under the lower leg or forearm. However do not cause further pain or unnecessary movement of the broken bone.
  • Bone immobilization: Depending on the site of the fracture and the severity of the injury, bone immobilization treatment options may include splints, slings, braces, plaster cast, and traction. Surgically inserted metal rods or plates (to hold the bone pieces together) may also be used, along with medications for pain relief.
  • A splint may be needed to support the limb. A splint is a medical device for the immobilization of limbs or of the spine. Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm.
  • A brace is a medical device that provides restraint and limits the motion of the affected area or joint, such as the knee. A brace permits weight bearing ambulation of the individual during healing of leg fractures or other traumas.
  • A sling for an arm may be needed to immobilize the area. A sling is a wrap (cotton or other material) placed around the neck and the arm for immobilization. If possible, elevate the fractured area and apply a cold pack to reduce swelling and pain. In an emergency, dial 911 for an ambulance.
  • Traction is the use of a pulling force to treat muscle and skeleton disorders, such as fractures. Traction is usually applied to the arms and legs, the neck, the backbone, or the pelvis. It is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. Traction can either be short-term, as at an accident scene, or long-term, when it is used in a hospital setting. Traction serves several purposes: it aligns the ends of a fracture by pulling the limb into a straight position; it ends muscle spasm; it relieves pain; and it takes the pressure off the bone ends by relaxing the muscle.
  • The function of a cast is to rigidly protect an injured bone or joint. Casts are usually made of either plaster or fiberglass material. A cast serves to hold the broken bone in proper alignment to prevent it from moving while it heals. Casts may also be used to help rest a bone or joint to relieve pain that is caused by moving it (such as when a severe sprain occurs, but no broken bones). Different types of casts and splints are available, depending on the reason for the immobilization and/or the type of fracture.
  • A plaster cast is made from rolls or pieces of dry muslin that have starch or dextrose and calcium sulfate added. When the plaster gets wet, a chemical reaction happens (between the water and the calcium sulfate) that produces heat and eventually causes the plaster to set, or get hard, when it dries. A person can usually feel the cast getting warm on the skin from this chemical reaction as it sets. The temperature of the water used to wet the plaster affects the rate at which the cast sets. When colder water is used, it takes longer for the plaster to set, and a smaller amount of heat is produced from the chemical reaction. Plaster casts are usually smooth and white. The cast typically begins to feel hard about 10-15 minutes after it is put on, but it takes much longer to be fully dry and hard. It is especially important to be careful with the cast for the first one to two days because it can easily crack or break while it is drying and hardening. It can take up to 24-48 hours for the cast to completely harden.
  • Cast placement depends on the location and severity of the fracture. During surgery with a closed or simple fracture, the two ends of the broken bone are lined up and held in place. The limb is thoroughly bandaged then the wet plaster is applied. Sometimes, once the plaster is dry, the cast is split into two and the two halves are then re-bandaged on the outside. This allows room for any swelling that may occur. An open or compound fracture has to be thoroughly cleansed in the operating room to remove debris prior to being set because a broken bone exposed to the open air is at increased risk of infection. Long bones (such as the thigh, or femur bone), are difficult to keep aligned and, in adults, are generally treated by surgically inserted metal rods, pins, or plates.
  • Healthcare professionals recommend: until the cast has properly set, avoid direct heat such as hot water bottles (heat may cause the plaster not to harden); rest the limb as much as possible to promote healing; use the techniques directed by nursing staff to walk or manage day-to-day activities. The use of crutches incorrectly may result in further damage; and avoid any lifting or driving until the fracture has healed. If itching is experienced, do not put anything inside the cast between the cast and the limb,. Instead, use a hairdryer to blow cool air into the cast. Avoid getting the cast wet, as wet plaster becomes soft and does not provide the necessary support. Wet plaster can also cause skin irritation. When showering, wrap the cast in a plastic bag and tape it directly to the skin, keeping the area water-tight. Healthcare professionals recommend seeking immediate medical help if swelling, blueness or loss of movement of the fingers or toes, sensations of pins and needles in the affected area, numbness, or increased pain occur.
  • Long-term outlook: In most cases, the cast can be removed after a few weeks but the limb must be handled with care for at least the next month or so. Leg fractures will take several months to heal. Muscles may be diminished in size or strength due to lack of use and may need rehabilitation, including strengthening exercises to recover from their immobilization.
  • Surgery: Surgery on fractures are very much dependent on what bone is broken, where it is broken, and whether the orthopedic surgeon believes that the break is at risk for movement once the bone fragments have been aligned. If the surgeon is concerned that the bones will heal improperly, an operation will be needed. Sometimes bones that appear to be aligned normally are splinted, and at a recheck appointment, are found to be unstable and require surgery. Signs of poor bone healing may include pain and uneven or protruding bone surfaces at the point of healing.
  • Surgery can include closed reduction and casting, where the bones are manipulated under anesthesia so that alignment is restored. Reduction is a procedure to position bone and bone fragments into proper position. A plaster cast is placed to hold the bones after the alignment. A bone fracture may also need surgically inserted metal rods, pins, or plates. Open reduction means that, in the operating room, the skin is cut open and pins, plates, or rods are inserted into the bone to hold it in place until healing occurs. Depending on the fracture, some of these pieces of metal are permanent (never removed), and some are temporary until the healing of the bone is complete and surgically removed at a later time.
  • Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. With some fractures, such as hip fractures, surgery is offered routinely because the complications of non-operative treatment include deep vein thrombosis (DVT, or blood clot in the legs) and pulmonary embolism (blood clot in the lungs. These complications may occur due to a stagnation of blood in the veins caused by prolonged immobility, which can promote blood clot formation in veins. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint. Prosthetic body parts, such as hip joints, may also be needed.
  • Pain control: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by musculoskeletal problems. Commonly used over-the-counter NSAIDs include ibuprofen (Advil® or Motrin®) and naproxen sodium (Aleve®). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam® or Voltaren®), nabumetone (Relafen®), and ketoprofen (Orudis®). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin.
  • The frequency and severity of side effects from NSAIDs vary. The most common side effects include: nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include: kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.
  • Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine®), hydrocodone/acetaminophen (Lorcet®, Lortab®, or Vicodin®), or oxycodone (OxyContin® or Roxicodone®), may be prescribed to treat bone fracture pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include: constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because individuals may become addicted to them.

Integrative therapies
  • Strong scientific evidence:
  • Calcium: Adequate calcium and vitamin D are deemed essential for the prevention of osteoporosis in general, including postmenopausal osteoporosis. Multiple studies of calcium supplementation in the elderly and postmenopausal women have found that high calcium intake may be of benefit for bone loss prevention, especially in the ankles, hips, and spine. Although calcium and vitamin D alone are not recommended as the sole treatment of osteoporosis, they are necessary additions to pharmaceutical treatments. The vast majority of clinical trials investigating the efficacy of pharmaceutical treatments for osteoporosis have investigated these agents in combination with calcium and vitamin D. So, although calcium alone is unlikely to have an effect on the rate of bone loss following menopause, osteoporosis cannot be treated in the absence of calcium. Treatment of postmenopausal osteoporosis should only be done under the supervision of a qualified healthcare professional.
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with hypercalcaemia (high levels of calcium in the blood), hypercalciuria (high levels of calcium in urine), hyperparathyroidism (high levels of parathyroid hormone), bone tumors, digitalis toxicity, ventricular fibrillation (ventricles of the heart contract in unsynchronized rhythm), kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or arrhythmia (irregular heartbeat). Calcium appears to be safe in pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
  • Vitamin D: Vitamin D is found in numerous dietary sources such as fish, eggs, fortified milk, and cod liver oil. The sun is also a significant contributor to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. Vitamin D aids in the absorption of calcium, thus making strong, healthy bones.
  • In adults with severe vitamin D deficiency, bone mineral is lost ("hypomineralization") and results in bone pain and osteomalacia (soft bones or "rickets"). Osteomalacia may result from deficiency of vitamin D in elderly patients, decreased absorption of vitamin D, patients with chronic malabsorption syndrome secondary to jejunoileal bypass, patients with partial gastrectomy, aluminum-induced bone disease, chronic liver disease, or kidney disease with renal osteodystrophy. Treatment for osteomalacia depends on the underlying cause of the disease and often includes pain control and orthopedic surgical intervention, as well as vitamin D and phosphate binding agents.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Good scientific evidence:
  • Magnet therapy: Several studies report that pulsed electromagnetic fields may improve fracture healing for fractures that have not healed properly, including long bone, scaphoid, metatarsal (foot bone), and vertebral fractures. Further research is necessary before a firm conclusion can be drawn.
  • Avoid with implantable medical devices like heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
  • Vitamin D: Without sufficient vitamin D, calcium absorption cannot be maximized and the resulting elevation in parathyroid (PTH) secretion by the parathyroid glands results in increased bone resorption, which may weaken bones and increase the risk of osteoporosis and fractures. Vitamin D supplementation has been demonstrated to slow bone loss and reduce fracture, particularly when taken with calcium.
  • Oral calcifediol or ergocalciferol may help manage hypocalcemia and prevent renal osteodystrophy in people with chronic renal failure undergoing dialysis. Renal osteodystrophy is a term that refers to all of the bone problems that occur in patients with chronic kidney failure.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Unclear or conflicting scientific evidence:
  • Arnica: Many patients use arnica to relieve pain postoperatively. However, further study is needed to further define the effectiveness of arnica in postoperative trauma (pain and wound healing). Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae family (sunflowers, marigolds or any related plants like daisies, ragweed or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.
  • Black tea: Black tea (Camellia sinensis) is from the same shrub as green tea and oolong tea. Each is processed differently. Preliminary research suggests that chronic use of black tea may improve bone mineral density (BMD) in older women and may prevent osteoporosis. Better research is needed in this area before a conclusion can be made.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use caution if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism and irritability.
  • Boron: Boron is a trace mineral found in the environment. Animal and preliminary human studies report that boron may play a role in certain metabolic functions, with effects on calcium, phosphorus, and vitamin D. However, research of bone mineral density in women taking boron supplements does not clearly demonstrate benefits in osteoporosis. Additional study is needed before a conclusion can be made.
  • Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions like breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.
  • Calcium: Calcium supplementation above the normal daily dietary intake has not been shown to be effective for bone stress injury prevention. Additional research is needed in this area.
  • Calcium supplementation in patients on long-term, high-dose inhaled steroids for asthma may reduce bone loss due to steroid intake. Treatment using the prescription drug pamidronate with calcium has been shown to be superior to calcium alone for the prevention of corticosteroid-induced osteoporosis. Long-term studies involving more patients should follow to confirm these preliminary findings.
  • Rickets (a softening of the bones in children potentially leading to fractures and deformity) and osteomalacia (bone softening) are commonly thought of as diseases due to vitamin D deficiency; however, calcium deficiency may also be another risk factor in sunny areas of the world where vitamin D deficiency would not be expected. Calcium gluconate is used as an adjuvant in the treatment of osteomalacia and rickets, as well as a single therapeutic agent in non-vitamin D deficient rickets. Research continues regarding the importance of calcium alone in the treatment and prevention of rickets and osteomalacia. Treatment of rickets and osteomalacia should only be done under the supervision of a qualified healthcare professional.
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with hypercalcaemia (high levels of calcium in the blood), hypercalciuria (high levels of calcium in urine), hyperparathyroidism (high levels of parathyroid hormone), bone tumors, digitalis toxicity, ventricular fibrillation (ventricles of the heart contract in unsynchronized rhythm), kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or arrhythmia (irregular heartbeat). Calcium appears to be safe in pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
  • Chromium: There is currently a lack of evidence for or against the use of chromium for the treatment of bone loss in postmenopausal women.
  • Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous (toxic). Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
  • Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, and fruits, as well as shellfish, avocado, and beef (organs such as liver). Osteopenia and other abnormalities of bone development related to copper deficiency may occur in copper-deficient low-birth weight infants and young children. Supplementation with copper may be helpful in the treatment and/or prevention of osteopenia and osteoporosis, although early human evidence is conflicting. The effects of copper deficiency or copper supplementation on bone metabolism and age-related osteoporosis require further research before clear conclusions can be drawn.
  • Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias and myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The United States Recommended Dietary Allowance (RDA) is 1,000?g for pregnant women. The RDA is 1300?g for nursing women.
  • Coral: Coral may strengthen bone and be effective for bone healing. Natural and man-made coral are currently being studied for use as substitutes for reconstructive surgery and bone grafts.
  • Coral may not be safe for consumption. Avoid if allergic or sensitive to coral. Avoid with kidney disease or if prone to kidney stones. Avoid if prone to infection. Avoid if pregnant or breastfeeding.
  • Creatine: Early studies examining the effect of creatine in aging suggest that creatine may increase bone density when combined with resistance training. Further studies in which creatine alone is compared with placebo are needed.
  • Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix®)). Use caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • DHEA: Laboratory studies have found that dehydroepiandosterone (DHEA) may improve bone mineral density. The ability of DHEA to increase bone density in humans is not clear at this time. Additional research is needed.
  • Few side effects are reported when DHEA supplements are taken by mouth in recommended doses. Side effects may include fatigue, nasal congestion, headache, acne, or rapid/irregular heartbeats. In women, the most common side effects are abnormal menses, emotional changes, headache, and insomnia. Individuals with a history of abnormal heart rhythms, blood clots or hypercoagulability, and those with a history of liver disease, should avoid DHEA supplements.
  • Evening primrose oil: Primrose oil has been suggested as a possible treatment for bone loss and osteoporosis. Well-designed human trials are needed before primrose oil can be recommended for osteoporosis therapy.
  • Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
  • Gamma linolenic acid (GLA): Some evidence from clinical study as well as observations of clinicians and dieticians has suggested that gamma linolenic acid (GLA) and eicosapentaenoic acid (EPA) may enhance the effects of calcium supplementation in elderly patients with osteoporosis. More clinical studies are required to produce results to determine the effectiveness in diverse elderly and middle-aged populations.
  • Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
  • Horsetail: Silicon may be beneficial for bone strengthening. Because horsetail (Equisetum arvense) contains silicon, it has been suggested as a possible natural treatment for osteoporosis. Preliminary human study reports benefits, but more detailed research is needed before a firm recommendation can be made. People with osteoporosis should speak with a qualified healthcare provider about possible treatment with more proven therapies.
  • Avoid if allergic or hypersensitive to horsetail or nicotine. Avoid with a history of chronic alcohol abuse, malnutrition, and kidney disorders. Use cautiously with abnormal heart rhythms, diabetes, gout, neurological disorders, and osteoporosis. Avoid in children. Avoid if pregnant or breastfeeding.
  • Hypnotherapy, hypnosis: There is inconclusive evidence from preliminary research on the use of hypnosis for bone fractures. Additional study is needed before a firm conclusion can be drawn.
  • Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
  • Phosphates, phosphorus: Early research shows that high amounts of phosphorus may have negative effects on bone density and bone metabolism. This is because phosphorus decreases bone formation and increases bone resorption.
  • Avoid if allergic or hypersensitive to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney or liver disease, heart failure, unstable angina (chest pain), recent heart surgery, hyperphosphatemia (high phosphate blood level), hypocalcemia (low calcium blood level), hypokalemia (low potassium blood level), hypernatremia (high sodium blood level), Addison's disease, intestinal obstruction or ileus, bowel perforation, severe chronic constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, or gastric retention. Avoid sodium phosphate enemas with congenital or abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity.
  • Physical therapy: Supervised or home-based physical therapy has been used in combination with resistance and endurance training in physically frail elderly women taking hormone replacement therapy to improve bone density. Although early study is promising, more studies are needed in this area. Physical therapy has also been studied as a method of shortening the duration of healing time following cast immobilization of fractures. Additionally, a supervised physical therapy program has been used in children with osteogenesis imperfecta, a genetic disorder in which bones are abnormally fragile and may fracture easily. Physical therapy in this population may improve aerobic capacity and muscle force and reduce fatigue. Overall, however, the evidence is still mixed and more study is needed.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Red clover: It is not clear if red clover (Trifolium praetense) isoflavones have beneficial effects on bone density. Most studies of isoflavones in this area have looked at soy, which contains different amounts of isoflavones, as well as other non-isoflavone ingredients. More research is needed on the use of red clover for osteoporosis.
  • Avoid if allergic to red clover or other isoflavones. Red clover extract may increase bleeding in sensitive individuals, including those taking blood-thinning medications, such as warfarin (Coumadin®). Use cautiously with hormone replacement therapy (HRT) or birth control pills, or with patients who have a history of breast cancer or endometrial cancer. Avoid if pregnant or breastfeeding.
  • Selenium: Because selenium levels and thyroid hormones have been found to be disrupted during trauma, selenium supplementation has been suggested as a treatment for patients with severe injuries. Presently, there is not enough evidence to recommend the use of selenium for this indication.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Soy: It has been theorized that soy (Glycine max) "phytoestrogens" (plant-based compounds with weak estrogen-like properties) such as isoflavones may reduce the risk of post-menopausal bone loss and osteoporosis. However, most studies have not been well designed or reported. Until better research is available, a firm conclusion cannot be made. Individuals at risk for osteoporosis should speak with a qualified healthcare provider about the therapeutic options for increasing bone mineral density.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Preliminary research suggests that tai chi may be beneficial in delaying early bone loss in postmenopausal women. Additional evidence and long-term follow-up is needed to confirm the effects of tai chi on osteoporosis.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while practicing tai chi may increase the risk of injury.
  • Tamarind: Preliminary study has examined the use of tamarind for skeletal fluorosis prevention. Although beneficial outcomes have been reported, results are not conclusive. Additional study is needed in this area.
  • Use cautiously with anticoagulants or pain relieving drugs, such as NSAIDS, aspirin, and acetaminophen. Use cautiously with vasoconstrictors or diabetes. Tamarind candy has been associated with lead poisoning and death. Avoid if pregnant or breastfeeding.
  • TENS (transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. There is not enough reliable evidence to make a firm conclusion regarding the use of TENS for pain from broken bones or acute trauma.
  • Avoid with implantable devices (e.g. defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps). Use cautiously with decreased sensation (e.g. neuropathy) or seizure disorders. Avoid if pregnant or breastfeeding.
  • Vitamin D: Some evidence implies that steroids may impair vitamin D metabolism, further contributing to the loss of bone and development of corticosteroid-induced osteoporosis. There is limited evidence that vitamin D may be beneficial to bone strength in individuals taking long-term steroids.
  • Supplementation with vitamin D2 has been reported to reduce anticonvulsant-induced osteomalacia. More study is needed.
  • Osteoporosis is common in patients with cystic fibrosis (due to fat malabsorption, which leads to a deficiency of fat-soluble vitamins such as vitamin D). Oral calcitriol administration appears to increase the absorption of calcium and decrease parathyroid concentrations, which may be of benefit for osteoporosis in cystic fibrosis patients.
  • Metabolic bone disease is common among patients with chronic liver disease, and osteoporosis accounts for the majority of cases. Varying degrees of calcium malabsorption may occur in patients with chronic liver disease due to malnutrition and vitamin D deficiency. Oral or injected vitamin D may play a role in the management of hepatic osteodystrophy.
  • Osteogenesis imperfecta (OI) is a genetic disease that consists of unusually fragile bones that break easily, often under loads that normal bones bear daily due to a malfunction in the body's production of collagen. Proper calcium and vitamin D intake is essential to maintaining strong bones and may play a role in treatment of osteogenesis imperfecta.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Vitamin K: Vitamin K appears to prevent bone resorption; adequate dietary intake is likely necessary for excess bone loss prevention and for osteoporosis prevention. Elderly or institutionalized patients may be at particular risk and adequate intake of vitamin K-rich foods should be maintained. Unless patients have demonstrated vitamin K deficiency, there is no evidence that additional vitamin K supplementation is helpful. However, vitamin K may play a role in the prevention and treatment of glucocorticoid-induced bone loss. Further research is needed to confirm these results. Over-the-counter vitamin K1-containing multivitamin supplements may disrupt warfarin anticoagulation in vitamin K1-depleted patients. Vitamin K-depleted patients are sensitive to even small changes in vitamin K1 intake.
  • Avoid if allergic or hypersensitive to vitamin K. Injection into the muscle or vein should only be performed by a healthcare professional; many serious side effects have occurred after injection. Menadiol (type of vitamin K that is not available in the United States) should be avoided with glucose-6-phosphate dehydrogenase deficiency. Conditions that interfere with absorption of ingested vitamin K may lead to deficiency, including short gut, cystic fibrosis, malabsorption (various causes), pancreas or gall bladder disease, persistent diarrhea, sprue, or ulcerative colitis. Avoid if pregnant. Use cautiously if breastfeeding.
  • Fair negative scientific evidence:
  • Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Preliminary evidence suggests that selenium supplementation does not significantly improve Kashin-beck osteoarthropathy, a disease endemic in selenium- and iodine-deficient areas.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Thiamin: Thiamin (also spelled "thiamine") is a water-soluble B-complex vitamin. It is also known as vitamin B1 or aneurine. Preliminary evidence indicates that supplemental thiamin may not be beneficial for hip fractures.
  • Thiamin is generally considered safe and relatively nontoxic, even at high doses. Avoid if allergic or hypersensitive to thiamin. Thiamin appears safe if pregnant or breastfeeding when taken in the recommended dosages.

Prevention
  • Prevention of bone fractures and improvement in bone healing include measures to prevent osteoporosis or bone loss.
  • Smoking cessation: Smokers lose bone more rapidly than nonsmokers. Among 80 year olds, smokers have up to 10% lower bone mineral density, which translates into twice the risk of spinal fractures and a 50% increase in risk of hip fracture. Fractures heal slower in smokers, and are more apt to heal improperly. Stopping cigarette smoking can help to partially reverse many of the harmful effects of having been a smoker.
  • Alcohol in moderation: Excessive alcohol has been associated with osteoporosis due to the degenerative metabolic effects of alcohol. Alcohol excess may inhibit calcium absorption and bone formation.
  • Healthy body weight: Being underweight is a risk factor for osteoporosis. Staying within a healthy weight for an individual is important. Extreme thinness is a risk factor for osteoporosis. The potential impact of thinness on risk of osteoporosis development is of particular interest in developing countries, because of the high incidence of starvation, and in industrialized countries where slimness is promoted as ideal and dieting has been shown to be the most important risk factor for the development of anorexia, which leads to malnutrition. The onset of anorexia nervosa frequently occurs during puberty, the time of life when maximal bone mass accrual occurs, thereby putting adolescent girls with anorexia nervosa at high risk for reduced peak bone mass. Too much weight may also lead to an increase in fractures.
  • Sunlight: Healthcare professionals recommend sun exposure of 15 minutes a day to hands and face to help the body make vitamin D. Vitamin D helps calcium be absorbed and used by the body. Avoid overexposure to the sun, as it may lead to melanoma in sensitive individuals, particularly those with fair skin.
  • Diet: A high protein diet or high coffee consumption increases calcium loss. Fiber, oxalates (in rhubarb, spinach, beets, celery, greens, berries, nuts, tea, cocoa), and high zinc foods (such as oysters and red meats) decrease the absorption of calcium. The plant estrogens found in soy help maintain bone density and may reduce the risk of fractures, particularly in the first 10 years after menopause.
  • Exercise: The amount and type of exercise will vary depending on age and bone health. An exercise program should be individually tailored to the individual's needs and capabilities. Overall, most individuals should aim to exercise for 30-40 minutes three to four times each week, with some weight-bearing and resistance exercises in the program.
  • Although exercise is important in the prevention of osteoporosis, women and teenage girls who exercise to an extreme degree can develop amenorrhea (cessation of menstruation) due to estrogen deficiency. Estrogen deficiency in younger women contributes to bone loss. Exercise has been reported to lower estrogen levels due to decreasing the amount of fat. Women still make estrogen after menopause, although they make it in their fat cells instead of in their ovaries. A doctor can help an individual with decisions about exercise and bone health. Both male and female athletes who practice excessive exercise without adequate caloric intake are at heightened risk of osteoporosis. Athletes who train hard while trying to keep their weight below a certain level for competitive reasons are at particularly high risk.
  • There are a number of important preventive measures an athlete can take. It is recommended by healthcare professionals to avoid abrupt increases in overall training load and intensity. Adequate rest between workouts is important. Running shoes tend to lose their shock-absorbing capacity by 400 miles, so it is important to change them frequently. Expert advice is needed for correct choice of insoles and taping techniques to prevent bone injury, such as a fracture.
  • Eliminating fall hazards: If an individual has osteoporosis, it is important not only to help prevent further bone loss, but also to prevent a fracture. Eliminating hazards in the house that can increase the risk of falling is important. Removing loose wires or throw rugs, installing grab bars in the bathroom and non-skid mats near sinks and in the tub, and not walking in slick shoes or socks is recommended by healthcare professionals. Healthcare professionals also recommend caution when carrying or lifting items, as this could cause a spinal fracture. Wearing sturdy shoes is important. Using a cane or walker is recommended by healthcare professionals if the individual has balance problems or other difficulties walking.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Centers for Disease Control and Prevention. . Accessed March 6, 2009.
  2. Hamera-Slynarska M. Pharmacological support of bone fracture healing. Ortop Traumatol Rehabil. 2000 Sep 30;2(3):63-5.
  3. McCann RM, Colleary G, Geddis C, et al. Effect of osteoporosis on bone mineral density and fracture repair in a rat femoral fracture model. J Orthop Res. 2007 Oct 24; [Epub ahead of print].
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). . Accessed March 6, 2009.
  5. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed March 6, 2009.
  6. Sprague S, Lutz K, Bryant D, et al. Complementary and alternative medicine use in patients with fractures. Clin Orthop Relat Res. 2007 Oct;463:173-8.
  7. Wlodarski K, Galus R. The histophysiology of fracture healing. Ortop Traumatol Rehabil. 2000 Sep 30;2(3):92-6.

Causes and risk factors
  • The strength of the bones depends on their size and density. Bone density depends in part on the amount of calcium, phosphorus, boron, and other minerals that bones contain. When bones contain fewer minerals than normal, they are less strong and eventually lose their internal supporting structure. Genetic and environmental factors, such as diet and exercise, also affect bone strength.
  • Osteoporosis is a disease of the bones that makes them weak and prone to fracture. By their mid-30s, most individuals begin to gradually lose bone strength and more bone is lost than can be replaced. As a result, bones become less dense and structurally weaker. Osteopenia refers to mild bone loss that is not severe enough to be called osteoporosis, but that increases the risk of developing osteoporosis. As this occurs, bones lose calcium, phosphorus, boron, and other minerals and become lighter, less dense, and more porous. This makes the bones weaker and increases the chance that they might break. If not prevented or if left untreated, osteopenia can progress painlessly into osteoporosis until a bone breaks or fractures.
  • Risk factors for developing osteoporosis include:
  • Gender: Fractures from osteoporosis are about twice as common in women as they are in men. Although women are four times more likely than men to develop the disease, men also suffer from osteoporosis. Women start out with lower bone mass and tend to live longer, increasing their risk for developing osteoporosis. They also experience a sudden drop in estrogen at menopause that accelerates bone loss, as estrogen helps with bone formation. Slender, small-framed women are particularly at risk because they have relatively less bone mass to loose. Men who have low levels of the male hormone testosterone also are at increased risk. From age 75 years on, osteoporosis is as common in men as it is in women.
  • Age: Bones weaken during normal aging in a process called resorption. Bone resorption is the gradual loss of bone. As individuals age, whether male or female, there is an average loss of 0.5% bone mass every year after age 50. The result is an increase in bone fractures, such as hip fractures.
  • Ethnicity: Caucasians and Southeast Asians are at the greatest risk of osteoporosis, leading to an increase in bone fractures. African American and Latino men and women have a lower but still significant risk of osteoporosis-related fractures. It is estimated that around 40% of U.S. Caucasian women and 13% of U.S. Caucasian men aged 50 years and older will experience at least one fracture due to bone loss in their lifetime. It is also estimated that in the United States, 54% postmenopausal Caucasian women are osteopenic and 30% are osteoporotic, and by the age of 80, 27% of Caucasian women are osteopenic and 70% are osteoporotic.
  • Heredity: Having a parent or sibling (brother or sister) with osteoporosis puts the individual at a greater risk for developing osteoporosis and bone fractures, especially if the individual also has a family history of bone fractures. An individual with a family member who has osteoporosis has a 50-85% increased risk of developing osteoporosis.
  • Body frame size: Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
  • Smoking: The impact of cigarette smoking on bone health is not well understood. Smoking may cause a decrease in bone density, although it is unclear whether this is a direct result of the action of smoking or other factors that are generally attributable to smokers. Smokers are usually thinner than nonsmokers, tend to drink more alcohol, may be less physically active, and may have poor diets. Women who smoke also tend to have an earlier menopause than nonsmokers. These factors place many smokers at an increased risk for osteoporosis apart from their tobacco use.
  • In addition, most studies on the effects of smoking suggest that smoking increases the risk of having a fracture. Results have found that the longer an individual smokes and the more cigarettes consumed, the greater the risk of fracture in old age. Smokers who fracture bones may take longer to heal than non-smokers. Significant bone loss has been found in older women and men who smoke. Studies suggest that second-hand smoke exposure during youth may increase the risk of developing low bone mass. Also, women who smoke often produce less estrogen and tend to experience menopause earlier than nonsmokers. Smoking cessations appears to reduce the risk of low bone mass and fractures.
  • Estrogen levels: Estrogen helps to increase bone density. The longer a woman is exposed to estrogen, the lower her risk of osteoporosis. Women have a lower risk of osteoporosis if they have a late menopause or they began menstruating at an earlier than average age. A history of abnormal menstrual periods, experiencing menopause earlier than the late 40s, or having the ovaries surgically removed before age 45 without receiving hormone therapy may also increase the risk of developing osteoporosis.
  • Health conditions: Health conditions caused by hormone imbalances, such as hyperthyroidism (too much thyroid hormone), hyperparathyroidism (too much parathyroid hormone), and Cushing's syndrome (too much adrenal hormone) may increase the risk for osteoporosis because they interfere with the regulation of the hormones that regulate bone formation. Gastrointestinal disorders, such as celiac disease and Crohn's disease, which affect absorption of calcium and vitamin D, also increase the risk of osteoporosis. Early onset menopause brought on by the removal of the uterus (hysterectomy) and the complete removal of the ovaries (oophrectomy) are associated with osteoporosis.
  • Chronic alcohol abuse has been associated with decreased bone mineral density in and is commonly listed as a risk factor for osteoporosis. Prevalence of osteoporosis in alcoholics has been estimated at 28-52%. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.
  • Individuals who experience serious depression have increased rates of bone loss. Depression activates the sympathetic nervous system, which responds to impending danger or stress, causing the release of a chemical compound called noradrenaline that harms bone-building cells (osteoblasts).
  • Women and men with eating disorders, such as anorexia nervosa or bulimia, are at higher risk of lower bone density in their lower backs and hips. Eating disorders have significant physical consequences. Affected individuals can experience nutritional and hormonal problems that negatively impact bone density. Low body weight in females causes the body to stop producing estrogen, resulting in a condition known as amenorrhea, or absent menstrual periods. Low estrogen levels contribute to significant losses in bone density. In addition, individuals with anorexia often produce excessive amounts of the adrenal hormone cortisol, which is known to trigger bone loss.
  • Other problems, such as a decrease in the production of growth hormone and other growth factors, low body weight, calcium deficiency, and malnutrition, all contribute to bone loss in individuals with eating disorders. Weight loss, restricted dietary intake, and testosterone deficiency may be responsible for the low bone density found in males with eating disorders. Studies suggest that low bone mass (osteopenia) is common in people with anorexia and that it occurs early in the course of the disease. Girls with anorexia are less likely to reach their peak bone density and therefore may be at increased risk for osteoporosis and fracture throughout life.
  • Medications: Certain medications may decrease the body's ability to absorb calcium and may increase the risk of developing osteoporosis. Postmenopausal women who have had breast cancer are at an increased risk of osteoporosis, especially if they were treated with medications such as anastrozole (Arimidex®), letrozole (Femara®), and exemestane (Aromasin®), which suppress estrogen. Women treated with tamoxifen (Nolvadex®) do not seem to develop an increase in bone loss.
  • Diuretics, or medications that prevent buildup of fluids in the body, can cause the kidneys to excrete more calcium, leading to thinning bones. Diuretics that cause calcium loss include furosemide (Lasix®), bumetanide (Bumex®), ethacrynic acid (Edecrin®), and torsemide (Demadex®).
  • Long-term use of the blood-thinning medication heparin, the drug methotrexate (Rheumatrex®), some anti-seizure medications, such as phenytoin (Dilantin®), and aluminum-containing antacids, such as Amphojel®, can also lead to bone loss by decreasing the absorption of calcium and depleting calcium from the body.
  • Cholestyramine (Cholestin®), used to control blood cholesterol levels, may decrease calcium absorption and increase the risk of osteoporosis. Gonadotropin-releasing hormones (such as Lupron®) used for the treatment of endometriosis may also decrease calcium absorption and increase the risk of osteoporosis. Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.
  • Corticosteroids, such as prednisone (Deltasone®), may lead to osteoporosis. Approximately 30-50% of individuals taking corticosteroids long-term develop osteoporosis. Relatively short courses (two to three months) of more than 7.5 milligrams of prednisone (Deltasone®) can cause significant bone loss. The common long-term use of corticosteroids in conditions, such as rheumatoid arthritis, results in a dramatic increase in vertebral and ultimately hip fracture rates. Corticosteroids are used for inflammatory conditions including allergic reactions, skin diseases (psoriasis, hives), and breathing problems; certain cancers; blood disorders; eye problems; arthritis; digestive problems; and for hormone replacement.
  • Low calcium intake: A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss, and an increased risk of fractures. Many foods contain calcium, but dairy products are the most significant source. Milk and dairy products such as yogurt, cheeses, and buttermilk contain an efficiently absorbed form of calcium.
  • Lack of exercise: Exercise can increase bone density at any age. Muscle pulling on bone builds bone, so weight-bearing exercise builds denser, stronger bones. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density.
  • Excess soda or coffee consumption: The link between osteoporosis and caffeinated sodas is not clear, but caffeine and phosphoric acid in the drinks may interfere with calcium absorption. Caffeine, also found in coffee and tea, is also a diuretic, which may increase mineral loss.

Types of bone fractures
  • Greenstick fracture: In a greenstick fracture, the bone sustains a small, slender crack. This type of fracture is more common in children, due to the comparative flexibility of their bones.
  • Comminuted fracture: In a comminuted fracture, the bone is shattered into small pieces. This type of complicated fracture tends to heal at a slower rate.
  • Simple fracture: In a simple fracture, or 'closed' fracture, the broken bone has not pierced the skin.
  • Compound fracture: In a compound fracture, or 'open' fracture, the broken bone juts through the skin, or a wound leads to the fracture site. The risk of infection is higher with this type of fracture.
  • Pathological fracture: In a pathological fracture, bones weakened by various diseases (such as osteoporosis or cancer) tend to break with very little force.
  • Avulsion fracture: Muscles are anchored to bone by tendons, which are a type of connective tissue. In an avulsion fracture, powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This type of fracture is more common in the knee and shoulder joints. Avulsion fractures are reported to be more common in children than adults. In adults, the ligaments and tendons tend to be injured, whereas in children the bone may fail before the ligament or tendon is injured. Children have a particularly weak point in their skeleton called the growth plate. This is the area of bone that is actively growing. In children, tendons or ligaments near a growth plate can pull hard enough to cause the growth plate to fracture.
  • Compression fracture: A compression fracture occurs when two bones are forced against each other. The bones of the spine, called vertebrae, are prone to this type of fracture. Elderly people, particularly those with osteoporosis, are at increased risk.
  • Stress fracture: A stress fracture, or hairline fracture, is an overuse injury. Because of repeated micro-trauma, the bone can fail to absorb the shock that is being put upon it and become weakened. Most often it is seen in the lower leg, the shin bone (tibia), or foot. Athletes are at risk the most, because they have repeated footfalls on hard surfaces. Tennis players, basketball players, jumpers, and gymnasts are typically at risk.
  • Hip fracture: A broken hip is a common injury, especially in elderly individuals. In the United States, hip fractures are the most common broken bone that requires hospitalization; about 300,000 Americans are hospitalized for a hip fracture every year. Women are two to three times as likely as men are to experience a hip fracture, because women lose bone density at a greater rate than men do. A hip fracture is a serious injury, particularly if the individual is older, and complications can be life-threatening. Fortunately, surgery to repair a hip fracture is usually very effective, although recovery often requires time and patience. Most people make a good recovery from a hip fracture. Generally, the better the individual's health and mobility before a hip fracture, the better their chances for a complete recovery.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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