The word “osteoporosis” simply means “porous bones”. Bones become porous, or less dense, with age. Bone is a dynamic, living tissue. It is constantly being broken down and rebuilt in a process known as remodelling, with up to 10 per cent of all bone mass undergoing remodelling at any point in time. As you age, the mineral-rich, internal part of the bone breaks down faster than it is rebuilt. It should not be treated as disease unless you experience one or more of the following symptoms over a period of time:

• Bone fracture
• Gradual loss of height
• Rounding of the shoulders
• Gum inflammation and loosening of the teeth
• Acute lower backache
• Swelling of a wrist after a minor fall or injury
• Trouble with nail, hair, teeth, gums, joints or spine
• Nocturnal leg cramps
• Rheumatoid arthritis
• Restless behaviour

People with osteoporosis suffer from a loss in bone mass and bone strength at a higher rate than expected with ageing. Their bones become weak and brittle, which makes them more prone to fracture. Any bone can be affected by osteoporosis but the hips, wrists and spine are the most common sites. Peak bone mass is reached between the ages of 25 and 35 years. After 35, bone mass is stable until, in women, it starts to drop with menopause.

While 6–18 per cent of women aged 25–34 have “abnormally low” bone density, hip-fracture rates for white women in the US and Britain begin to rise abruptly between the ages of 40 and 44 — much earlier than menopause. This drop occurs more slowly in males. According to the Australian Institute of Health and Welfare (AIWH), an estimated 692,000 Australians (3.4 per cent of the total population) had doctor-diagnosed cases of osteoporosis in 2007–08. Women accounted for the majority of cases (81.9 per cent). The disease occurs mainly in people aged 55 and over (84 per cent).

Risk factors

Risk factors that increase the likelihood of developing and aggravating osteoporosis are:

Being female — women are four times more likely to develop osteoporosis than men. According to Osteoporosis Australia, one in two women and one in three men over 60 will have an osteoporotic fracture in Australia. Though most women start to think of bone loss only at menopause, it often begins years before, as 50 per cent of the bone loss over a woman’s lifespan occurs before menopause even begins. However, the rapid bone loss at menopause occurs due to a sharp decline in oestrogen.

A hysterectomy — that is, removal of both ovaries with no hormone replacement therapy (HRT).

Body type — having a thin, small-framed body.

Heredity and race — the risk increases if there is a history of osteoporosis and/or bone fractures in your family. Caucasians are at a higher risk than Asians and African Americans.

Lack of physical activity — especially activities such as walking, running, tennis and other weight-bearing exercises.

Mineral deficiencies — lack of calcium and vitamin D, magnesium and other mineral deficiencies from the modern diet of processed foods.

Cigarette smoking and excessive alcohol — heavy drinkers and smokers often have poor appetite and poor nutrition.

Medication — taking certain medicines, such as corticosteroids (anti-inflammatory drugs used to treat asthma, arthritis, lupus etc), aluminium-containing antacids, anti-seizure drugs and overuse of thyroid hormones.

Thyroid conditions — hyperthyroidism, hyperparathyroidism and certain forms of bone cancer, anorexia nervosa, scoliosis and gastrointestinal disease.

Western treatments

Medical management, especially if you are at a high risk of having osteoporosis, may involve hormone replacement therapy (HRT) and/or calcium supplementation. These are recommended to prevent fractures if taken during or soon after the start of menopause and then on a continual basis. HRT does not rebuild bone but it is supposed to prevent further bone loss.

A far better approach advocated by Western practitioners of complementary medicine is to aim for prevention of osteoporosis. We will consider this approach before we get to the specific Ayurvedic recommendations. Natural approaches to osteoporosis treatment focus on supporting the dynamic, bone-rebuilding process and not on replacing the natural and healthy decline of oestrogen during menopause.

A key element of prevention will be a high-complex-carbohydrate, low-fat diet, relatively low in protein, limiting servings of red meat to lean cuts no more than three times a week. Red meat is very high in phosphorous, as is soft drink, and high phosphorous intake extracts calcium from bones to keep calcium/phosphorous levels in balance. You should concentrate on eating dark-green, leafy vegetables and plan to get enough calcium every day. If your diet is mostly whole grains, greens, beans and vegetables, your bones will be more apt to stay healthy on relatively less calcium, as long as you also exercise and get out in the sun for vitamin D.

Some high-calcium foods to include in your diet are:

• Milk, yogurt and cheese
• Soft-boned fish and shellfish, such as salmon with the bones, sardines and shrimp
• Vegetables, especially dark-green, leafy vegetables, broccoli, kale, collards
• Beans and bean sprouts as well as tofu (if processed with calcium, and organic to avoid genetically modified soy)

Make sure you get adequate vitamin D, too. You can get vitamin D from exposure to sunlight and from foods such as vitamin D-fortified milks, salmon, tuna and shrimp.

Follow a program of regular, weight-bearing exercise at least three or four times a week, such as walking, jogging, tennis, weight training, low-impact or non-impact aerobics — anything that puts weight on the bones, 20 minutes five times a week or 30 minutes three times a week.

Don’t smoke. Smoking makes osteoporosis worse. Smokers, along with those who consume two or more alcoholic drinks daily, are at highest risk of osteoporosis.

Avoid cola and soft drinks, as these are too high in phosphate, which directly interferes with calcium absorption.

Take 2000mg of vitamin C a day. Vitamin C is involved in collagen synthesis and repair.

Take 300–800mg of magnesium a day. It is found in organically grown vegetables, whole grains, seaweed (kelp) and meats such as turkey. Over-consumption of processed food (refined grains and too few dark green leafy vegetables) is usually the culprit in magnesium deficiency.

Take 2–12mg of boron a day. The minimum dose of boron needed (2mg) each day is easily met with a daily diet rich in fruit, nuts and vegetables.

Take 25,000 units (15mg) of betacarotene a day. Betacarotene is made into vitamin A, which promotes a healthy intestinal epithelium, which in turn is important for optimal absorption of nutrients, and it also promotes strong joints. It is found in abundance in yellow and orange vegetables such as pumpkin and carrots and also in dark-green, leafy vegetables, especially broccoli.

 

An Ayurvedic approach

Before we look at an Ayurvedic approach to osteoporosis it will help to become familiar with some terminology. Ayurveda, the ancient medical system from the Vedic civilisation of India, teaches that health is maintained by the balancing of three subtle energies known as doshas: vata, pitta and kapha.

A dosha is a functional intelligence that commands the tissue of the body and gives the body its vast functional capability. Doshas have no obvious material qualities and cannot be objectively studied. Yet their influence in the body is all pervasive. They are the unseen intelligence orchestrating the estimated 1 billion physiological processes occurring every second in the human body. They are made up of mahabhutas (great elements), namely space, air, fire, water and earth.

Vata — made up of space and air, it is responsible for all movement, communication and transport in the body.

Pitta — made up of mostly fire and some water and air, it is responsible for digestion, hormone activity, enzyme activity in the body and all conversion processes.

Kapha — made up of water and earth, it governs structure, stability and lubrication of membranes and joints, and wherever there is movement.

Some other terms we will encounter are:

Ama — toxins, undigested food or uneliminated waste material.

Dhatus — according to Ayurveda are basic seven body tissues, which are responsible for the functioning of the systems and organs and the structure of the body.

Ojas – the subtle essence of all vital fluids, responsible for health, harmony and spiritual growth. It is a wholesome biochemical substance that nourishes all body tissues and has a direct influence on the nature and quality of physical, mental and emotional life. High ojas means immunity is high in the body.

Vata stage of life (from middle age onward) — characterised by the drying, separating and immobilising aspects of vata: drive starts to wane, skin dries and wrinkles, body becomes frail and weak, there is loss of muscle tone and flexibility, hair thins and greys, strength and stamina gradually decrease, mind loses its clarity and bones become less dense.

Vitiated dosha — deranged or “spoilt” dosha due to presence of ama (toxins) in the tissue.

Ayurveda and osteoporosis

Vata body-type individuals or people in a vata stage of life are likely to experience loss of bone density at a higher rate. From an Ayurvedic perspective, any vata imbalance or disease pattern in the body is indicated by many symptoms, including stress, anxiety, constipation, dry skin, hypertension, restlessness, insomnia, PMS or many menstrual disorders, irritable bowel syndrome and inability to relax.

Some of the behavioural patterns that can create a vata imbalance in the body are being in stress or reacting to stress with anxiety, physical exhaustion, mental strain and overwork without giving the body a chance to relax and re-create; addictive patterns; lack of sleep; suffering emotionally from grief, fear or shock; travelling (flying or long car journeys); stringent diets; eating cold, raw or dry foods frequently; and living in cold, dry and windy weather.

The risk for osteoporosis will be higher in a person of vata body, old people and women after menopausal age. For women, a regular menstrual cycle is important for building and maintaining bone strength throughout her reproductive years.

 

 

Ayurvedic treatment

The best approach to osteoporosis is to focus on creating health through knowledge of proper lifestyle and removing the root imbalances in the basic biological functions of digestion, metabolism, circulation, tissue development and nervous system activity. Ayurveda focuses on balancing doshas, especially vata in this case, and detoxification so that the dhatus are free of ama. Then the body’s homeostatic mechanisms, will more efficiently help your metabolism adjust to the natural ageing process. When the body’s natural healing ability is strengthened and root imbalances in basic bodily functions are removed, the bone rebuilding process will be positively influenced.

An Ayurvedic approach to osteoporosis will involve detoxification and balancing the doshas, especially vata dosha, using panchakarma, an ancient Ayurvedic detoxification process. The panchakarma treatment consists of internal oleation (taking ghee or flaxseed oil to prepare the doshas and impurities to be removed from the tissues), snehana (massage), bashpa swedana (sweating), kati basti (medicated oils and herbal preparations introduced into the rectum for the purpose of flushing toxins from the intestinal tract) and shiro dhara (warm herbal oil is poured in a thin steady stream through a spicket directly onto the forehead and sixth chakra), followed by purging to remove all the vitiated doshas from the body systems.

It should be noted that bastis are often referred to as enemas but offer many more healing benefits than simply evacuating the colon. This is because the medication that’s given rectally goes to the deeper tissues, including the bones. Bastis gently eliminate the excess vata and help restore health and wellbeing. In this case, a herbal oil of vata shamak or dashmoola will be appropriate.

Food supplements and rejuvenators such as shatavari (Asparagus racemosus), ashwagandha (Withania somnifera) and bala (Sida cordifolia), amalaki (Emblica officinalis) should be taken in the powdered form in the dose of 2–3g daily.

Shatavari and vidari kanda (Ipomoea digitata) mixed in equal parts, or just shatavari taken on regular basis (½ tsp twice daily) with warm milk, help to make up for oestrogen loss in the metabolic cycle. These herbs are food precursors of oestrogen and progesterone.

Abhyanga, or self-massage using sesame oil, is good for vata pacification.

Ashokarishta (herbal wine of ashoka bark) has silica, sodium, potassium, phosphate, magnesium, iron and calcium. It is used for many uterine disorders and is a good herb for the time of menopause. Dashmoolarishta (herbal wine of dashmoola) is a classic Ayurvedic mixture of 10 herb roots and is used for vata pacification. These preparations should be taken after consulting an Ayurvedic practitioner.

Chewing a handful of sesame seeds each morning provides at least 1200mg of natural calcium. These seeds won’t clog arteries, as dependence on calcium from dairy products may do. One part black or white sesame seeds, half part shatavari, with ginger and raw sugar or jaggery added to taste, is good for the bones.

The vata-pacifying diet includes warm, heavy, moist and slightly oily foods that give you strength. Frequent small meals, mildly spiced and with only a few different types of foods per meal are recommended. Don’t eat when you are nervous or worried. If possible, eat with your friends/family in a loving atmosphere as that is vata-pacifying.

Amalaki is an Ayurvedic medicine for the bones, nourishing them, strengthening the teeth and causing hair and nails to grow. Five grams of powder in one cup of water twice a day is used as a general tonic. Triphala can be used on regular basis as a tridoshic tonic.

To complement the effects of these Ayurvedic treatments:

• Consume calcium-rich foods such as milk, sesame and spinach, reducing red meat at the same time.
• Nourish yourself with whole, natural foods. Avoid too many saturated fats such as cheese and butter. Instead, use ghee and healthy oils such as sunflower and corn oils.
• Limit your intake of tea or coffee to a maximum of one to two cups daily; avoid completely if possible.
• Make exercise a daily routine (after consulting your doctor) to keep yourself fit.
• Practise yoga and meditation for calming effect and mind control. If osteoporosis has begun to develop, yoga exercises should be done gently, with care, as there could be a real danger of breaking a bone.
• Develop a positive approach towards menopause and life in general.
• Avoid smoking and drinking alcohol.
• Excess vata may also be reduced to proper levels by having regularity of routine, enough rest, meditation and using vata-pacifying essential oils.

 

References available on request.

 

Neerja Ahuja specialises in diet/lifestyle management and Ayurvedic panchakarma detox treatments. W: www.ayurveda-awareness.com.au T: (08) 6262 9182