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Friday, June 24, 2016

Osteoporosis

Kyle J. Norton (Scholar)

Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                Osteoporosis

Osteoporosis is defined as a condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time. It is a widespread degenerative disease of skeletal joints and often associated with senescence in vertebrates due to excessive or abnormal mechanical loading of weight-bearing joints, arising from heavy long-term use or specific injuries(6).

                                                  The symptoms 

1. Lower back pain, as a result of fractured or collapsed vertebra
People with Osteoporosis are susceptible to lower back pain in patient with osteoporosis than those without, according to a cross-sectional study, conducted from October 2002 to March 2003 to gather data from 24,435 adults aged 20 years and older selected randomly from Taiwan’s general population(34). Vertebral fractures(35) and collapsed vertebra(36) in many cases is found to be associated to lower back pain as well as loss of height(35) The Osteoporosis rate of frequent low back pain is higher in women in comparison to those of male(37).

2. Loss of height over time(38)
Vertebral fracture cause of spinal core damage is associated to significant height loss in patients with osteoporosis(35), according to a study of 231 men and women over the age of 65 underwent DXA scan of their spine and hip (38). Osteoporosis patients with chronic obstructive pulmonary disease (COPD) are found to associate to excessive height loss(39).

3. A stooped posture
Postural deformity of patients with osteoporosis is associated to contributed risk factor for postural instability and falls(40)(41). Spinal curvature on postural instability in patients with osteoporosis may influence lumbar kyphosis (lower back curvature) in spinal inclination and a risk of fall(42).

4. Easy bone fracture
Easy bone fracture may be results of a gradual loss of bone density(43)(44). Intravenous infusion of zoledronic acid (5 mg) at 12 months, found that Zoledronic acid treatment was associated with a significantly reduced risk of vertebral fracture(fractures in the spine, hip and wrist), among men with osteoporosis(45). The treatment was also found to be effective in prevention of osteoporotic bone fractures in postmenopausal women(46)(47).

5. Neck and low back pain
Neck and low back pain, frequent in female are prevalent and highly associated in patients with headache and osteoporosis(48)(49), according to 1-year prevalence of neck pain and low back pain in the Spanish population(48).

6.  Depression
Spine bone mineral density(BMD) was negative correlations between anxiety, stress, but depression was found to have a unique significant contribution to the explained variance in right and left hip BMD, according to Bar Ilan University(50). In a population-based retrospective cohort study, researchers at the China Medical University Hospital showed that risk of osteoporosis increase in patients with depression:(51).

7.  Other symptoms
Women with osteoporosis re more likely to experience certain psychosomatic(52)(53), gastrointestinal(52) and swelling(52) and vasomotor symptoms(52), especially depressive symptom if compared to women in generally good health(52)(53).
According to the joint study by University of Porto Medical School and Universidade Nova de Lisboa, knee and hip in patient with osteoarthritis features: differences on pain, function can totally effect the quality of life(54).

8. Etc.

                                The Causes 
A. Primary causes
Bone loss is a natural aging process occurs during the normal aging process. Primary osteoporosis is a type of  osteoporosis due to involutional losses(65) causes by hormone imbalance associated with aging(59), In men, it is the result of low testosterone(59) and, in women, additional losses related to natural menopause(60)(61). The abnormal secretion(deficiency) of  GH due to the effects of age, sex, diet, exercise, stress, and other hormones may also induce the loss of bone density(4)(5) as a result of reduced interaction with GH receptors on osteoblasts(6)(7). Sleep deprivation generally suppresses GH release, also can contribute to the onset of bone loss(8).


2. Secondary causes
 According to the study by Department of Medicine, College of Physicians and Surgeons, Columbia University, other disorders or medication exposures causes of osteoporosis are referred as "secondary" osteoporosis(62) also include
1. Other hormone imbalance
Thyroid dysfunction such as hyperthyroidism and hypothyroidism can interfere with the secretion of thyroid hormone of which can have a direct impart on the bone mineral density(11)(10). Bone mineral density deficiency has been found to associate to patient with parathyroid hormone excess(12)(13), especially at the lumbar spine, total hip, and femoral neck in postmenopausal women with osteoporosis(13).
Massachusetts General Hospital, insisted that patient with a higher-than-normal levels of the hormone prolactin in the blood are at higher risk for the development of osteoporosis(14).
Hypogonadism is a condition in which the body doesn't produce enough testosterone due to decrease on alkaline phosphatase (AP), can have a direct influence to the deficiency of bone mineral density, according to Weill Cornell Medical College(16). 
"Pituitary disorders, can also influence bone metabolism and cause secondary osteoporosis, induced a significant increase of fracture risk", the Wroclaw Medical University said(17). The University of Auckland

2. Calcium deficiency
Calcium, one the mineral has a significant effect on bone turn over in patient with osteoporosis(19), Patient with parathyroid hormone (PTH), the disease with removed calcium from the bone(22) has a progressive link to the early onset of osteoporosis(23). Calcium at dosage of at least 1200 mg has been suggested by researchers in reducing the incidence of non-vertebral and hip fracture(18). Deficiency of vitamin D and calcium in patient with osteoporosis has shown to induced risk of post fracture in associated to the rate of mortality in elder, according to the prospective analysis, conducted by University of Helsinki, Helsinki(20).  But the University of Auckland in searching of meta-analyses with data for > 50 000 older adults suggested that calcium with or without vitamin D has only weak, inconsistent effects on fracture, and should not be recommended for fracture prevention in adults with no diagnosed osteoporosis(21).

3. Low serum of Vitamin D
Vitamin D found in a number of food such as liver,  and fish oil but abundantly under sunlight has a direct effect for the body in absorb calcium and and phosphate(28) for prevention the onset of osteoporosis(24), through its effect on the control of osteoblast(26) function and bone extracellular matrix  mineralization(25), according to the Erasmus Medical Center Rotterdam. In deed, according to the VU University Medical Center, Vitamin D used for stimulate the absorption of calcium may have a direct influence on bone mineral density and bone turnover as vitamin D deficiency is associate to patient with osteoporosis and fracture bone(27). Dr. Yoshida T and Dr. Stern PH. said" Vitamin D analogues has provided new therapeutic options for increasing bone mineral density and reducing fractures"(28)

Adding to secondary causes of osteoporosis, according to Clarke 2010, Confavreux 2009, Lieben 2009; Zhou 2011 include
4. Oxidative stress
Oxidative stress is an imbalance between production of free radicals and the ability of the body antioxidants in neutralizing its harmful effects. Oxidative stress has shown to damage the cellular components of osteoblasts, causing osteoporosis(29), according to the Shanghai Jiaotong University School of Medicine. In aging population, with estrogen deficiency and increased in reactive oxygen species (ROS) production(31), risk of osteoporosis is in the increase, Dr. Manolagas SC said" (there is) an emerging evidence provides a paradigm shift from the "estrogen-centric" account of the pathogenesis of involutional osteoporosis"(30)

5. Hyperglycemia
Hyperglycemia is a medical condition of elevated blood sugar, often associated to diabetes(32).
Insulin dependent diabetes mellitus is shown to associate with osteoporosis and increased fracture rate as a result of modulate osteoblast gene expression(66), function and bone formation(33).
In deed,  Individuals with type 2 diabetes has found to associate to increased fracture risk(68), despite normal bone mineral density (BMD) and high BMI-factors, the joint study said(67).
Interestingly, "Although type 1 diabetes is associated with lower bone density, those with type 2 diabetes usually have elevated bone density. Yet for both types of diabetes, bone appears to be more fragile for a given density" said Dr. Schwartz AV1,Dr. Sellmeyer DE.(69).

6. Inflammation
Would there be an association between osteoporosis and inflammation? According to the study in
patients with chronic pancreatitis, bone bone turnover and highest systematic inflammation was shown to be associated patients with osteoporosis(70). In post-menopausal women, withdrawal of estrogen exhibited the production of pro-inflammatory cytokines, the primary mediators in accelerated bone loss(71), reduced osteoclastic bone resorption(71) of that induced risk of osteoporosis(71). According to the Medical University Innsbruck, chronic inflammatory diseases such as inflammatory bowel diseases (IBD) not only affect bone metabolism but also are frequently associated with the presence of osteoporosis(72)..

7. Metabolic syndrome(3)
Metabolic syndrome is the collection of symptoms of which can lead to cardiovascular disease and diabetes(73)(74). According to the study by Tongji University School of Medicine, metabolic syndrome has a negative effect on bone mineral density in men but positive effect in women(75).
In support to above claim, the Military Hospital Mohammed V, Morocco showed that menopause  women with MS have a protective effect of osteoporosis due to higher BMD at the hip and spine(76).

[In adolescent, low bone mineral density or secondary osteoporosis is more frequent in young people and is generally due to an underlying cause(9) 
8. Nutritional deficiencie 
Calcium and vitamin D in many research are best known for theirs effectiveness in managed osteoporosis(77). Children and adult with long term deficiency of vitamin D  have found to associate with low mineralization in theskeleton, leading to rickets(78). According to study, Poor nutritional conditions in early life are linked to greater prevalence of OA due the gradual deterioration of function(9).
(see calcium and Vitamin D for more information)]

9. Long-term Glucocorticoid therapy
Glucocorticoid is chemical used to relieve pain caused by inflammation as a result of the over active immune system in induced certain diseases, such as allergies, asthma, autoimmune diseases, and sepsis. The chemical is found to associate to the development of osteoporosis due to its adverse effect in induced apoptosis of steoblasts(79). According to the Chiba University study, glucocorticoid-induced osteoporosis (GIOP) in children with autoimmune diseases by inflating the a high level of bone turnover markers, interferring with femoral neck bone mineral density (BMD), serum bone alkaline phosphatase, and urinary deoxypyridinolin(80)

10. Immunosuppressive therapy
Medication used to suppress the immune system to prevent rejection of transplanted organs and tissues may also induced osteoporosis(83). Patient with solid organ transplant (SOT) patient often are found to have low levels of calcium and vitamin D due to the effects of the medication induced malnutrition(81) In fact, reduced exposure of glucocorticoid and appropriate physical activity before and after transplant has shown to aid the future management of osteoporosis in these patient(81)(82).
Dr. Bia M said" Pretransplant period or early post transplant and should include assessment of fracture risk as well as metabolic factors. Bone mineral density measurement is recommended in all patients even if its predictive value for fracture risk in the transplant population..... Management of bone disease should be directed toward decreasing fracture risk as well as improving bone density"(84)

12. Medication
Medication used for treatment of chronic diseases such as cancers and diabetes have found to associate to the development of osteoporosis, according to The University of Texas MD Anderson Cancer Center(85) and joint study(86) respectively. In patient with schizophrenia, the use of antipsychotic drugs have shown to induce hyperprolactinemia through inhibited hypothalamo-pituitary-gonadal axis and reduced bone mineral density(15)
Other medication may induce osteoporosis include, aromatase inhibitors, gonadotropin-releasing hormone agonists, thyroid replacement therapy, antiepileptics, antidepressants, antipsychotics, lithium, gastric acid lowering agents, thiazolidinediones, loop diuretics, heparins and warfarin, vitamin A and cyclosporine, according to the study of Drug-induced Osteoporosis in the Older Adult led posted in Medscape(87).

13. Medical conditions
13. HIV infected patient
Menopausal women with HIV-infected Postmenopausal Women is found to associated to an additional risk of predictor for osteoporosis and fractures. According to the study, the prevalence of osteoporosis in patient with HIV infected is much higher in uninfected postmenopausal women(89),

13.2. Spinal cord injuriesPatient with spinal cord injuries are associate to bone resorption rate is hypercalciuria, low PTH, and 1,25 (OH)2 vitamin D of that exhibit the risk of decreased bone density and increased risk of fracture,  such as lower extremity fractures, according to DR. Ott SM(92). The injures can also can lead to abnormal calcium and phosphate metabolism and the parathyroid hormone (PTH)-vitamin D axis of that increse risk of osteoporosis(93).
In deed, according to the Swiss Paraplegic Center, spinal core injures can cause long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence(94).

13.3. Weight loss surgery
Weight loss surgery such as gastric bypass is found to increased risk of lower bone mineral density, especially in the femoral neck and among patients who had greater baseline BMD and greater reduction in ghrelin concentrations(95). The American University of Beirut-Medical Center study also concerned of the decreased mechanical loading, calcium, metabolic acidosis, and elevated peptide YY(97) and vitamin D malabsorption(97) with secondary hyperparathyroidism(97), deficiency in other nutrients in patient with weight loss surgery(96).

13.4. Premature ovarian failure
 Premature ovarian failure is an early onset of menopause in  women younger than age of 40 with the medical occurrence of amenorrhea, hypergonadotropinemia and estrogen deficiency(98) of which can lead to bone loss and increased risk psychological stress and mortility(99).
In a retrospective analysis of 223 consecutive new referrals conducted by King's College Hospital NHS Foundation, women with premature ovarian insufficiency are associated to the risk of low bone minerals density(100).
14. Eating disorder
Anorexia nervosa (AN), type of eating disorder can induce loss of bone mineral density(91), impaired bone quality(91) and increased fracture risk(91) as a result of abnormal production of estrogen(91) in influence to weight loss(91) and menstrual disorder(90).

15. Menstrual disorder
Menstrual disorder is a result of the abnormal production of hormones in  women menstrual cycle.
15.1. Abnormal production of prolactin is produced by the anterior lobe of the pituitar can lead to menstrual disorder. Hyperprolactinaemia cause higher serum prolactin levels of that increase of the risk of osteopenia or/and osteoporosis, according to Medical University of Poznań(101).
15.2. Amenorrhea
Young women with an age when bone formation should still be occurring may put themselves at risk of osteoporosis if amenorrhea is untreated(102).
Dr. Golden NH said" Female athlete triad is a condition ....... characterized by the triad of amenorrhea, disordered eating and osteoporosis"(103).


                            The Risk factors

1. Young Age at Diagnosis, Decreased Lean Mass
In the study to investigate the prevalence and identify the risk factors of osteoporosis, researchers at the Korea Cancer Center Hospital, Seoul, showed that young age at diagnosis(55), and low lean mass(55)(56) are found to be risk factors of the development of osteopenia and osteoporosis(55) 

2. Male sex(55)(56) and adult (GH) growth hormone deficiency or excess
There was the high prevalence of osteoporosis and osteopenia in male sex, a low lean mass, and adult growth hormone replacement(58). Patient with  either GH deficiency (GHD) or GH excess are found to have bone, metabolic, and somatic impairments(57). 

3. Chlamydia pneumoniae
Chlamydia pneumoniae is an bacterial infection causes of pneumoniae. According to the "Sapienza" University, there is an association between the presence of Chlamydia pneumoniae DNA both in osteoporotic bone tissue and peripheral blood mononuclear cells (PBMCs) and the increase in circulating resorptive cytokines(63), probably due to induced of bone loss(64).

5. Race
Race with limit intake of lactos, the lactose a disaccharide sugar found in milk may be associate to risk of osteoporosis(104). According to the joint study lead by Université Libre de Bruxelle, intake of dairy can confer a favourable benefit with regard to bone health(104).
Low calcium intakes(106), and Lactose intolerance(107) also has an impact on low bone density(105)(106) among Hispanic-American and Asian-American populations may create an elevated risk for osteoporosis(105)(107).

6. Family history
The family history is found positively in related to a significant, independent risk factor for osteoporosis in U.S. women aged of 35 and over, according to the the National Center on Birth Defects and Developmental Disabilities(108). 
According to the, risk of  osteoporosis in women was 8.3%. Patient with  positive family history of the diseases have a increased risk of 19.8%  of which is considered as a independent risk of osteoporosis(109). Dr. Betancourt Ortiz SL said "Family history of bone fractures might serve for identifying post-menopausal women at increased risk of loss of BMD", according to his study at the at the "San Juan" Specialities Hospital in Riobamba (Province of Chimborazo, Republic of Ecuado(110)
7. Skin color and body size
Skin color, body size and bone mineral density (BMD) may also be an independent  risk of  osteoporosis among three groups of postmenopausal women: 104 healthy black women, 45 healthy white women, and 52 osteoporotic white women with vertebral fractures(111), especially on large body size on bone mineral density effects in black and white(111)(112). In fact, family history, use of contraceptive device and postnatal environmental factors, are found to associate to infant bone size and bone mass of which may induce long-term consequences in the increased risk of osteoporosis in later life(113).

8. Diet and lifestyle
Certain diet, including typical American diet with high intake of salt, soda, caffeine, process foods, such as can foods, etc,... have been found to induce risk of osteoporosis, according to Elizabeth Ward, MS, RD. In deed, high salt intake was found to associated with osteoporosis and an increased calcium excretion in urine(114) of which induced loss of calcium and risk of osteoporosis.
Negative lifestyle such as smoking(116), heavy alcohol consumption(117)  may reduce bone mineral density and increase the incidence of fragility fracture,
Positive lifestyle such as  green tea drinking(118), dairy products(119) and physical activity(120) improved bone minerals density of which reduced risk of osteoporosis(115).

9. Heavy alcohol intake or alcoholism
Moderate intake of alcohol use may have beneficial effects on bone mineral density of that reduced risk of osteoporosis. Oppositely, Heavy alcohol intake or alcoholism disrupts calcium and bone homeostasis(121) of which leads to reduce bone mineral density and increase the incidence of fragility fracture, according to the study by Albert Einstein College of Medicine and Montefiore Medical Center(122).

10. Smoking and lower serum IGF-I and IGF-binding protein (IGFBP)-3
 levels
The study of middle-aged Korean men, conduced by the Sungkyunkwan University School of Medicine,   suggest that current smoking history, and history of smoking and lower serum IGF-I levels are risk factors for lower BMD  of which can induce risk of osteoporosis(123). In deed, insulin-like growth factor I (IGF-I) and IGF-binding protein (IGFBP)-3 showed to have a significant relation to relationship to osteoporotic spinal fracture and bone mass distribution(124)(125) of that can be used as a predictor for the severity of osteoporosis, and risk of bone fracture associated with osteoporosis(124).

11. Other risk factors
Patient suffered from chronic illness, such as chronic kidney disease(126), chronic inflammatory rheumatic Disease(127, chronic obstructive pulmonary disease(129),cancers(130), etc.... are found to associate to risk of osteopenia and osteoporosis(128) due to slowly decreased bone mineral density, vitamin and calcium diet content, etc...


                                        Diagnosis 

According to the Clinical practice guidelines, the diagnosis and management of osteoporosis include screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations(131)

If you are experience certain symptom of osteoporosis, the tests which your doctor order include
1. Laboratory testsThe aim of the tests is to check for serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone(132), according to The Catholic University of Korea.

2. Dual energy X-ray absorptiometry (DXA)
Dual energy X-ray absorptiometry (DXA) is one most common test to measure the total bone density of including spine, hip, wrist etc... The test forms an important role in the evaluation of individuals at risk of osteoporosis,(133)(134).

3. Quantitative Ultrasound and computed tomography (QCT)
Quantitative ultrasound (QUS) is a portable and accurate technology used to evaluate skeletal status including bone density at the lumbar spine and hip without the use of ionizing radiation(137). In compared to the conventional dual energy x-ray absorptiometry (DEXA), quantitative ultrasound yielded results comparable to DEXA and may therefore be used for screening patients osteoporosis(135) and can be a helpful tool for assessing pathological fractures(136), especially for those with CRD(135)

Computed Tomography (CT) scanner.a technology for measuring properties of bone at peripheral skeletal sites for noninvasive bone mineral measurement(138) with greatest advantages of high precision and sensitivity of the vertebral spongiosa site(139) and the latter region of the skeleton, correlates well with the spinal fracture index(140)

Dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT), which are now the standard methods for assessing osteoporosis severity and treatment efficacy(141). But according to the Universitätsklinikum Schleswig-Holstein, in cross-sectional study of males with glucocorticoid-induced osteoporosis (GIO, quantitative computed tomography (QCT), High-resolution quantitative computed tomography (HRQCT)-based were more superior to DXA in diferentiating between patients with vertebral fracture status(142).

4. Etc.

                 The diseases associated to Osteoporosis

Misdiagnosis of osteoporosis is rare, but it can happen in comprised with misdiagnosis with diseases.

1. Haemochromatosis
Hemochromatosis is a genetic defect of gene (C282YY) and a compound heterozygous mutation (C282Y/H63D)(143). Patient with the disease is associated to risk of 25% of osteoporosis and 41% of osteopenia(144). Patient with osteoporosis-hemochromatosis with misdiagnosis(146) and delay diagnosis(147) of hemochromatosis can induce complications of liver cirrhosis and carcinoma, diabetes or heart failure(145).

2. Myeloma
Multiple myeloma (Myeloma) is a type of cancer originated from plasma cells in the bone marrow induced symptoms of bone pain, infection, anemia, bleeding, back pain certain neurological symptoms, etc.,..(148). 
In the United States, each year approximately 700,000 vertebral body compression fractures due to osteoporosis and bone metastasis
with approximately 70,000 of these resulting in hospitalization(151). Clinical manifestations of multiple myeloma may be derived directly from the malignant infiltration of bone marrow associated to osteoporosis(149), through alter the functions of bone-resorbing (osteoclasts) and bone-forming (osteoblasts) cells, inducing skeletal destruction(150).
According to the Homerton University Hospital, the coexistent osteoporosis and multiple myeloma can induce multiple vertebral fractures in the context of severe osteoporosis causes of vertebral collapse fracture(152).

3. Wilson's Disease 
Wilson's Disease is a genetic disease causes of disorder of copper metabolism(excessive amounts of copper accumulate in the body, especially in the liver and central nervous system). The high prevalence of the osteoporosis in patient with Wilson's diseases(154) may lead to fractures(155) and lower bone mineral density (BMD)(155) due to bone loss,...Patient with WD comprised of severe neurological involvement, low BMI, and/or amenorrhea ate found to associate to risk of fracture, probably due to lower bone mineral density(153)

4. Crohn's disease 
Crohn's disease  is a chronic inflammatory bowel diseases associated to the intestine(156). Patients with inflammatory bowel disease(IBD) are found to associate to metabolic bone diseases such as osteopenia and osteoporosis, a study in Japan insisted(157). In a cross-sectional study of 388 patients with IBD aged 20-50 years, lower bone mineral density, including  mineral density of the femoral neck, total femur and lumbar spine is coexiated in patient with Crohn's disease(158). The study of Iranian patient, risk of developing osteopenia and osteoporosis increase in patient of Crohn's diseases with smoking, corticosteroid use, age, and BMI(159).

5. Kidney disease
Kidney disease is a chronic disease with gradual loss of renal function over a prolonged period of time. Lifestyle-related diseases, including chronic kidney disease have been shown to have a possible effect on bone metabolism of which can lead to decrease in bone mineral density and an increase risk of fracture(160)(161). According to Capital Medical University Beijing, osteoporosis biomarkers in some case can act as predictors for diagnosis of chronic renal insufficiency in elder patients(162). Patient with pyperparathyroidism due to renal insufficiency may lead to turbulence of bone metabolism and unbalance between serum calcium and phosphorus(162). Renal osteodystrophy damage of bone morphology and abnormal bone metabolism by CKD due to P and Ca abnormalization of mineral metabolism(163).

6. Lupus
 Lupus, is an immune disorder disease causes of chronic inflammation associated to the attack of immune system against its won tissues(164). Osteoporosis is considered as a long term complication of patient with lupus due to its effect in reduced quality of life, increased mortality rates and increased risk of new vertebral and non-vertebral fractures(165). According to the University of Birmingham, in a cross sectional study of a large cohort of patients with systemic lupus erythematosus (SLE), the prevalence of reduced bone mineral density (BMD) and fractures, and risk factors for fractures were significantly high(166). According to Medicines that May Cause Bone Loss, patient with lupus may need to take medicines, including steroids, to control their symptoms of which can cause bone loss and osteoporosis(167).

7. Multiple sclerosis(MS)
Multiple sclerosis, is an immune disorder associated to demyelinating disease of the central nervous system due to the production of high-affinity anti-myelin immunoglobulin (Ig)G antibodies by the immune system(168). Patient with MS have found to at risk of low bone mineral density and fracture(170). According to Kings College London, used of glucocorticoid for treatment of MS although reduced mobility but increased risk for osteoporosis(169). The University Hospital of North Norway study suggested that due to high prevalence of osteoporosis in patients with multiple sclerosis and the share of aetiological risk factors such as smoking and hypovitaminosis D, as well as pathogenetic players such as osteopontin and osteoprotegerin, BMD should be measured shortly after diagnosis(171).

8. Ankylosing spondylitis(AS)
Ankylosing spondylitis, a type of spinal arthritis, is an inflammatory disease affected your spine. According to the study of 204 patients with AS by University of Gothenburg and 55 AS patients and 33 healthy controls by Izmir Tepecik Training and Research Hospital elevated serum levels of Wingless protein(Wnt-3a) and low levels of osteoprotegerin (OPG) may be used as biomarkers of bone metabolism in relation to osteoproliferation and osteoporosis(172)(173) respectively.
The Cochin Hospital study insisted that both AS and osteoporosis related to both systemic inflammation and decreased mobility and vertebral fracture risk(174), but so far there are no effective treatment in decreased risk of fractures(174)

9. Celiac Disease(CD)
Celiac Disease, is an multisystem autoimmune disorder in which such the disgestive system is highly sensitive to gluten Celiac disease. Patient with CD may experience secondary osteoporosis of that can lead metabolic osteopathy and joint and muscle problems and risk fracture(176),due to abnormal bone mineral metabolism (total calcium/albumin, 25-OH vitamin D3 and parathormone levels in serum) and bone mineral density (densitometry)(175).
According to the Hacettepe University, in the study of 34 children with untreated celiac disease at diagnosis and in 28 patients on a gluten-free diet, suggested that early diagnosis and treatment of celiac disease during childhood with a strict gluten-free diet improves bone mineralization and against the devopment of osteoporosis(177).

10. Diabetes
Patient with diabetes have a higher risk of developing osteoporosis. Indeed, osteoporosis and its related fractures, are clinically significant and commonly problem in diabetes type I and II patients(181). An India study of a prospective cross-sectional study on 150 patients with T2DM showed that patient with type 2 diabetes have significantly lower BMD at both femoral neck and lumbar spine compared to age and sex matched healthy controls(178). Postmenopausal women with non-insulin dependent type 2 diabetes mellitus (T2DM) also have an increased risk of osteoporosis(180) and vitamin D deficiency(179).

11. Hyperparathyroidism
Hyperparathyroidism is a medical condition of excessive serum of thyroid hormones in the blood stream induced a variable degree of osteopenia(184). Patient with the disease is at the greater risk of in developed osteoporosis and and fractures, especially in the population of in the young and in the early postmenopausal period, according to the La Sapienza University, but have a protective effect on trabecular bone in elderly postmenopausal women(182).
The study by Queen's University, Kingston, found that the alternation of vitamin D in these patient may lead to the development of secondary hyperparathyroidism in primary osteoporosis and osteopenia(183)

12. Hyperthyroidism

Hyperthyroidism is a medical condition of over production of thyroid hormone by the thyroid glands. Patient with hyperthyroidism, including subclinical hyperthyroid is at increased rate to risk of osteoporosis(185)(188) of which can lead to reduce in bone resorption and in ossified bone mineral deposition(185). In thyrotoxicosis patients with Graves' disease, according to the Yokohama Rosai Hospital, the resorption and formation was imbalance may result of decreased bone mineral density (BMD) and increased risk for osteoporotic fracture(186). Dr. Sato K. said" ...the gradual decrease in bone mineral density (BMD),..... In young patients, the decreased BMD is reversible, but not in post-menopausal women"(187)

13. Cushing’s syndrome
Cushing’s syndrome is a medical condition of over production of corticosteroid hormones (hypercortisolism) by the adrenal cortex of that can lead to higher risk of osteoporosis of that can induce further fractures and bone loss(189). Glucocorticoid therapy used mostly for treatment of the disease may elaborate the impaired the replication, differentiation and function of osteoblasts and induce the apoptosis of mature osteoblasts and osteocytes(190)(191). Dr. Suzuki Y. said" for management of GC-induced osteoporosis,....alendronate and risedronate are recommended as first-line treatment. Ibandronate, teriparatide, and active vitamin D3 derivatives are recommended as alternative option...."(192).

14. Leukemia and Lymphoma
Leukemia is defined as condition of abnormal increase of white blood cells produced by the bone marrow and/or the lymphatic system(193). According to the study by the University of Ottawa, increased odds for fracture, reduced lumbar spine (LS) and bone mineral density(BMD) as a result of vertebral compression, a serious complication of childhood acute lymphoblastic leukemia (ALL)(195).
Lymphoma is defined as a condition of cancer in the lymphatic cells (lymphocytes) of the immune system originated in lymph nodes. It represents a group of over 20 types of cancers(194).
According to the John Radcliffe Hospital, lymphomas share some common pathological and clinical features with multiple myeloma (MM), including the association with osteoporosis(198), such as correlating serum levels of osteoclast activating cytokine(198)
Chemotherapy used for treatment of leukemia and lymphoma is associated to high rate of osteoporosis and osteopenia(196)(197).

15. Sickle Cell Disease(SCD)Sickle Cell Disease is a severe case genetic disorder of anemia caused by mutation of hemoglobin in the red blood cells, afflicting the oxygen absorption. Children with sickle cell anemia is associated to risk of lower bone mineral density(199). In adult with with SCD, the prevalence of abnormal bone mass density (BMD) is high (60%) with a significant low serum level of vitamin D3 and low testosterone hormone in those with very low bone mass density (BMD)(200). Dr,.Patil PL and Dr. Rao BV. said" Early diagnosis of this disease by family physicians will enable initiation of therapy..........patients education regarding management of modifiable risk factors linked with osteoporosis"(201).

15. Thalassemia
Thalassemia, also known as Mediterranean anemia, is a mild form of genetic blood disorder affecting the formation of hemoglobin. 
 There are strong evidence and indication of the association among children, adolescents and young adults with thalassaemia major (TM) in the development of the osteopenia/osteoporosis of that can induce the skeletal abnormalities, fractures, spinal deformities, nerve compression and growth failure, if the diagnosis is delay(202). The diseases is found to contribute to seriously diminished bone mineral density (BMD) as a result of an unbalanced bone turnover with an increased resorptive phase(203).
In fact, Osteopenia-osteoporosis syndrome (OOS) have shown to affect over 60-80% β-thalassemia major (β-TM) patients(204), according to the University College London Hospitals. 



                                 The Complications 

Pain, Fractures, Vertebral, Wrist, Rib fractures are associated with Osteoporosis, according to the study of New advances in imaging osteoporosis and its complications(205).

1. Bone fracture
Bone fracture is considered as one of most serious complication of osteoporosis, due to loss of bone mineral density. Even minimum mechanical stress can easily head for fracture(206)(207). According to the Department of Diagnostic Imaging - AOUC, most common fracture sites, other than spine and hip are distal radius, forearm, proximal humerus, other femoral sites, ribs, pelvis, tibia and fibula, metatarsal bone and calcaneum(207). Dr. Parkinson IH and Dr. Fazzalari NL in the differentiation of 
Whole bone geometry and bone quality in distal forearm fracture said" Fracture of the distal radius is a sentinel for future increased risk of other "osteoporotic" fractures"(208). Certain nutritional supplements have shown effectively in reduced risk of fracture, such as vitamin K2(209)(210), vitamin D, calcium(212)
In deed,over weight and high body mass index (BMI) are associated to risk of lumbar spine and hip fracture in menopausal women and men as a result of poor balance and frequent falls(211).
The Health Quality Ontario said".....long-term exercise programs in mobile seniors and environmental modifications in the homes of frail elderly persons will effectively reduce falls and possibly fall-related injuries in Ontario's elderly population.A combination of vitamin D and calcium supplementation in elderly women will help reduce the risk of falls by more than 40%,..."(213).

2. Pain
Chronic pain is often induced poor quality of life in patient with osteoporosis, affecting daily living and functional status(215) and in some cases, causing mental health, such as anxiety and depression  to certain patients(214).
Exercise training program in osteoporotic patients improved balance and level of daily function, quality of life and decreased experience of pain and use of analgesics(215). Analgetic agent in most is used for elder patient with osteoporotic lower back pain(216).
In a Randomized placebo controlled trial, on self reported pain and quality of life in an elderly population, conducted by the International College of Osteopathic Medicine, Cinisello Balsamo, treatment other than mainstream medicine, showed to improvement of psychological and quality of life factors probably due to the effect on pain relief(217).

3. Bone Deformity 
Deformity, dysmorphism, or dysmorphic feature is a major abnormality in the shape(214).
According to the Japanese Population-Based Osteoporosis (JPOS) cohort study by Kinki University Faculty of Medicine, lower trabecular bone score (TBS) in bone density was associated with higher risk of vertebral fracture over 10 years in associated to the prevalence of vertebral deformity(218).
Elderly patients with osteoporotic neck pain, is associated marked thoracic kyphotic deformity(219).  

                                                           
                  The Prevention and Management 
The prevention and management of osteoporosis are always important due to the prevalent of the diseases in  in all populations and all ages(221), especially to elder, causing a significant physical, psychosocial, and financial consequences(220).

                                   The Diet

Certain foods are found to associate to reduce risk of osteoporosis, according to the dietitian of Canada(222)
1. Dairy products
With high amount calcium, diary product, including milk, yogurt plays an important role in reduced risk of osteopororsis. In a review of 139 papers published since 1975 and describing studies, higher intake of dairy products is contributed to higher intake of calcium of that induce substantial augmentation of the protective effect of osteoporosis(223). The study of 170 women aged 32 to 59 in bone mineral density (BMD), daily consumption of dairy products and dietary calcium and some non-modifiable risk factors may contrite to good bone health(224). 
The Myongji University supported the intake of dairy product and higher calcium foods beans, fish, seaweeds, and fruits may contribute to the Ca absorption and prevention of osteoporosis in later life(226). In fact, dairy products also attenuate the risk of the disease due to its amount of vitamin D in induced the calcium absorption(227).
Unfortunately, according to the study by Purdue University, Purdue University higher dairy product consumption is only associated with greater hip BMD in men, but not in women. Calcium supplementation intake protected bone loss in both sex(225).

2. Sardines
Vitamin D found abundantly in sardines is associated to induce absorption of intestineal calcium of which contribute to reduced risk osteoporosis(227). According to Dr. Gennari C, intake of fish including sardine together with milk, yoghurts and cheese, the main source of calcium and few vegetables and fruits may provide the RDA is 700-800 mg/day for lower the risk of aosteoporosis(228)

3. Green tea
Epidemiological studies have shown an strong association between tea consumption in prevention of age-related bone loss in elderly women and men(233).In obese female rats fed with high-fat diet and caloric restricted diet, green tea polyphenols (GTP) supplementation increased all factors in reduced risk of osteoporosis, including increased femoral mass and strength, trabecular thickness and eroded surface at proximal tibia, and insulin-like growth factor-I and leptin,...(229).  Intake of Green tea polyphenols (GTP) in conjunction of Tai Chi (TC) is considered as a effective strategies of reducing the levels of oxidative stress, as well as induced the potential as alternative tools to improve bone health in this population(230).
Green tea, epigallocatechin-3-gallate (EGCG) are found to be a lead compounds for the treatment of bone resorption diseases, through inhibition of the formation and differentiation of osteoclasts(231)(232).

4. Organic Soybean and sesame seed
Intake of soy bean oil exhibited significant increase in BMD (bone mineral density), accompanied with improved level of Ca as it is considered as a functional foods in retarding risks of osteoporosis associated with estrogen deficiency(233), probably through restoring minerals, antioxidant enzymes, antioxidant biomarkers, oxidative stress markers, inflammatory indices(234) according to the in ovariectomy in rats(233a)(234). In fact, in post menopause women, phystestrogens, including isoflavones, have a great similarity with estradiol, principal endogenous estrogen may contribute to the reduced risk of osteoporosis and other menopause symptoms(235). Unfortunately, soy protein and isoflavones (either alone or together) did not affect BMD, they should not be considered as effective interventions for preserving skeletal health in older women

Ingestion soy isoflavone extracts (not soy protein or foods containing isoflavones) supplements increased lumbar spine BMD in menopausal women, but not femoral neck, hip total, and trochanter BMD(237), but other suggested that soy protein and isoflavones (either alone or together) did not affect BMD, they should not be considered as effective interventions for preserving skeletal health in older women(236) according to study.

5. Calcium-fortified foods 
Calcium-fortified foods such as orange juice, cereal, enriched breads, grains, and waffles, etc. may provide rich sources of calcium of that is necessary to reduce bone mineral loss, especially in elder.
Oyster shell rich in calcium may be included in many different diet formulas, especially lentil soup,has a significant effect on minimized risk factors associated with osteoporosis, such as tibial weight, total protein, total calcium and phosphorus with noticeable reduction in ALP activity(238).
According to the Texas Woman's University, consumption of calcium-fortified cereal bars exhibit significantly improve dietary calcium intake of healthy women(240).
Other calcium-fortified foods(242) also have a beneficiary effect in improvement the the sources of calcium and prevented risk of osteoporosis, include powdered lobster shell(239), vitamin D-and calcium-fortified soft white cheese lowers(241),.....

6. Green leafy vegetable (Coccinia grandix Voigt.)
Green leafy vegetable such as spinach, kale, turnips, collard greens has found to have a persistent effect in reduced risk of osteoporosis, through enhancing calcium absorption(243), with some of the difference accounted for by the phytate, oxalate(243), and dietary fiber content of the vegetables(242), according to the study of 19 healthy adult Thais women aged 20 to 45.
In 13 healthy adults in a randomized cross-over design study of spinach absorbability of calcium is very low in comparison to milk produce as a result of oxalative effect(244).

Finally, we would like to remind readers that selection of alkali-generating foods and less acid-generating foods and, can significantly improve bone health of postmenopausal Iranian women, together with adequate dietary calcium intake(297).



 Antioxidants and Osteoporosis

Oxidative stress can induce impairment of bone mass and fragility fractures through its effects in causing apoptosis in osteoblasts, due to continuously generated of reactive oxygen species (ROS), such as H2O2-induced oxidative damage-implications(246) involved lipid peroxidation, protein damage, and DNA lesions of that exhibit the increased risk of osteoporosis(245)(248).
Antioxidant enzymes, including superoxide dismutase, glutathione peroxidase, and catalase reduced the excessive production of free radicals in the organism, and the imbalance between the concentrations of these and the antioxidant defenses have found to attenuate the risk of osteoporosis (OP) in postmenopausal women, according to the study by the Adnan Menderes University School of Medicine(247). Further more, decrease antioxidant defenses due to aging may also may contribute to this process(250).
Dietary and endogenous antioxidants were consistently lower in patients with osteoporosis, according to University of Perugia, of that can lead to decrease antioxidant defenses and promoting pathogenesis of osteoporosis(249).

The  Antioxidant Vitamins
1. Vitamin C
The one of free radical scavenger with function in remove or de-activate impurities and unwanted reaction of oxygen species plays an important role in antioxidant defense in reduced risk of osteoporosis, in a study of 75 subjects with osteoporosis and 75 controls(249).
In a 17-year follow-up from the Framingham Osteoporosis Study, dietary vitamin C has found to exhibit a protective effect on bone health in older adults(251), with significantly fewer hip fractures and non-vertebral fractures(251). In oxidative stress, Not orally, administration of vitamin C may prevent osteoporosis in menopausal women at high doses to postmenopausal women throguhplasma antioxidant activity(252).
The The University of Melbourne study insisted that antioxidant vitamin E or C supplements may suppress bone resorption in nonsmoking postmenopausal women, by improved bone formation and resorption(253).

2. Vitamin A
Low retinol concentrations, a derivative of vitamin A may associated to modest fracture risk in adjustment for BMI and serum concentrations of α-tocopherol(254). According to the study by University of Sheffield, serum retinol, retinyl palmitate, and beta-carotene found in multivitamin or cod liver oil supplementation may induce lower risk of fracture depending to age, total hip BMD(255). Dr. Crandall C. said" Retinol intake from diet or supplements is negatively associated with lumbar, femoral neck, and trochanter bone mineral density (BMD),....(But) it is not yet possible to set a specific level of retinol intake above which bone health is compromised" (256).
According to the UMDNJ-Robert Wood Johnson Medical School, deficiency of vitamin A and other dietary factors, such as protein, vitamin K, phytoestrogens, and other nutrients, -might also contribute to the risk for osteoporosis(257).

3. Vitamin D
Vitamin D, found abundantly when exposed your skin on sunlight and played an essential role in the absorption of calcium has been found to have a beneficiary effect on patient with osteoporosis. Dr. Gennari C. said" daily intake of 700-800 mg of calcium and 400-800 IU of vitamin D. This is an effective, safe and cheap means of preventing osteoporotic fractures"(258).
In a cross-sectional study involved 2942 men and 7158 women aged 40-75 years, deficiency of vitamin D (serum 25(OH)D levels below 20ng/mL) found in in 75.2% of the entire study population. is associated to significantly high prevalence of osteoporosis risk(259)(260).
Ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet in the aging population, has shown to induce risk of osteoporosis(261).
According to Italian Society for Osteoporosis "The highest tolerated daily dose has been identified as 4,000 IU/day. Vitamin D supplementation should be carefully monitored in patients at higher risk of vitamin D intoxication (granulomatosis) or with primary hyperparathyroidism"(262).

4. Vitamin E
Lower serum of vitamin E  and  vitamin E:lipid ratio levels are associated with osteoporosis in early postmenopausal women through reduced bone mineral density(BMD)(263). In acommunity-dwelling elderly people in Taiwan and in postmenopausal women of Northwest India studies, vitamin D receptor (VDR) variability such as gene polymorphism and physical activity are associated to low handgrip strength (LHS) and osteoporosis (OST)(264)(265).
In fact, the imbalance of osteoclastic and osteoblastic activities in osteoporosis, may be prevented with with prolonged intake of antioxidant vitamin supplementation(266), the study Patil Medical College and Hospital suggested.

5. Vitamin K
Synthetic vitamin K2  found to associate to the inverse correlation between the changes of lumbar bone mineral density and serum undercarboxylated osteocalcin in children treated with glucocorticoid and alfacalcidol(268) has been used in therapy for treatment of osteoporosis, especially in the prevention of fractures in postmenopausal women, as it modestly increased lumbar spine BMD, and reduced the incidence of fractures (mainly vertebral fracture),..(267). Short-term effect of vitamin K administration improved BMD of the lumbar spine associated with suppression of both bone formation and bone resorption(269) and dietary of synthetic vitamins K2 and D3 induced protective effects through decreased bone mineral density(270) in patients with chronic glomerulonephritis, the Hamamatsu University School of Medicine suggested.

The Antioxidant Minerals
1. Selenium
 Selenium, one of the powerful antioxidant in promotion of optimal antioxidative status and greatest immune defense, many studies suggested(273)(274). It also plays an essential role metabolic processes, immune function, thyroid hormone metabolism, male infertility, neoplasms and cardiovascular disease in other research(276).
The rabbits study by the Ankara University, showed that combination of  selenium with vitamin E and vitamin C induced more significant effect than combinations of vitamins to prevent structural alterations in these model bones(275).
Unfortunately, subchronic exposure to selenium(278)(277) and diazinon(277) may be a possible risk factor for osteoporosis, according to the animal study by Georg-August University and Constantine the Philosopher University, respectively. Contrasted to the above studies, in postmenopausal women, Dr, Pedrera-Zamorano JD and the research team at the University of Extremadura, insisted that elevated selenium intake may negatively affects bone mass of women over the age of 51 but only if calcium intake is also less than 800 mg / day(279).

2. Magnesium
Magnesium plays an important role in bone regeneration if it is used together with calcium in form of mesoporous magnesium–calcium silicate (m-MCS)(280) as it improved the cell-positive responses, including the attachment, proliferation and differentiation of MC3T3-E1 cells(281).
Magnesium intake, necessary for bone health, according to the study of 73,684 postmenopausal women exhibited improvement of bone mineral density (BMD) in the hip and whole but did not automatically transforming to lower the risk fractures(282)(283), Patient with osteoporosis is found to have lower levels of magnesium of that effect the function of bone formation, decrease production of sex hormone and other nutrients deficiency, such as calcium, of which is important for bone health(284).

3. Calcium
Calcium found mostly in the skeleton of human body is considered as one of the most important trace mineral with direct interaction with osteoporosis. Deficiency of calcium in most case, depending to the levels of vitamin D(285) is found to associate to risk factor of osteoporosis(286). The dietary sources of calcium are dairy products (milk, yoghurts and cheese) fish (sardines with bones), few vegetables and fruits. supplement may be necessary if dietary sources are scarce or not well tolerated(287)
Dr. Meunier P.said" It is now possible to partly stop bone loss in elderly people and it is never too late to prevent hip fractures with calcium and vitamin D supplements"(288).
Because of the important of levels of vitamin D in related to skeleton health, screening the 25(OH)D, baseline 25(OH)D levels may reduce risk for mortality and falls in older population(289). Other researchers suggested that the screening of serum of vitamin D is important due to its function in influence to digestive absorption of calcium(290)
Daily doses of 400-800 IU of vitamin D, given alone or in combination with calcium, are able to reverse vitamin D insufficiency, to prevent bone loss and to improve bone density in the elderly, according to University of Siena(287).

In need, sold in bottle, found in every corners of the foods store, needless to say for their promotion on the counters on pharmaceutical and drug locations, synthetic mineral calcium, magnesium and vitamin D3 combination are exposed by vitamin giants as a osteoporosis reduced supplement of that induced many buyers from the older population.

Beside calcium (Ca), fluoride, magnesium several trace elements, minerals copper (Cu), manganese (Mn) and zinc (Zn), are essential in bone metabolism as cofactors for certain enzymes(271). In take of calcium supplementation with and without the addition of zinc, manganese (5.0 mg/d) and copper significantly prevent bone loss on spine in postmenopausal women, according to a 2 years, double-blind, placebo-controlled trial(272).

The important of minerals copper, manganese, zinc and fluoride in related to risk factors of osteoporosis?
4. Copper(Cu)
Intake of copper supplement is recommended to post menopausal women due to its direct effects with other minerals, such as magnesium, zinc and calcium in reduced risk of mineral deficiency causes of low bone density(291)(292). According to Dr. Zheng J and the research team at the Sun Yat-sen University, low serum levels of copper Cu are found to associate to increase risk of osteoporosis and suggested that a well-designed studies with adequate control for confounding factors are necessary for future investigations(293).

5. Manganese(Mn)
Levels of serum of manganese may have a direct impart in influence risk factor of osteoporosis in postmenopausal women(294), probably due to Mg transport mechanisms into the cell(294).
According to the Shandong Agricultural University, deficiency of manganese Mn can decrease trabecular thickness, trabecular number and trabecular bone area of that induce risk of osteoporosis in chicken study(296).

6. Zinc(Zn)
Trace mineral zinc is best known for its function as nutritional factor in the growth of human body. The levels of zinc decreased slowly in the conjunction of aging progression(298).
  Zinc, as an essential trace element, or genistein, is found to increase bone mass through stimulating the formation of osteoblastic bone and inhibiting osteoclastic bone resorption, according to Dr. Yamaguchi M at the University of Georgia(299).
Some researchers suggested that the increased the inflammatory response and worsens bone biomechanics by immunity may induce osteoporosis in animal with even a marginal zinc deficiency(300). And zinc deficiency can exaggerate the bone loss risk(293), especially with patient with diabetes(301).

7. Fluoride
Sodium fluoride, according to some researchers may be the most potent agent for treatment of spinal bone mass deficiency(302). In a randomized placebo-controlled trial of 65 postmenopausal osteoporosis, slow-release sodium fluoride (SR-NaF) or fluoride treatment, virtually eliminated new spinal fractures, vertebral fracture rate in comparison with placebo(303).
The University of Texas Southwestern Medical Center researchers insisted that used in conjunction with calcium citrate, slow-release sodium fluoride administered for about 2.5 years, improved vertebral fractures, increased spinal bone mass without decreasing the radial shaft bone density(304), especially in menopausal women(305).

The antioxidants
Antioxidants may have a direct and profound influence to the risk factor of osteoporosis(306), due to its effect in bone turn over. Oxidative stress (OS) continuous generating reactive oxygen species (ROS), such as H2O2-induced oxidative damage-implications has found to consist a correlation between bone mineral density (BMD) and OS in postmenopausal women, according to the jopint study lead by the Aligarh Muslim University(307).

1. Lycopene
Lycopene found abundantly in tomato, watermelon, grapefruit has significantly increased antioxidant capacity and decreased oxidative stress, through activation of bone resorption markers in reduced the risk of osteoporosis(308). On postmenopausal models, risk of osteoporosis increase by 10 fold due to reduce production of Sex hormones. Treatment with lycopene suppressed bone turnover to restore bone strength through down-regulated osteoclast differentiation concurrent with up-regulating osteoblast together with improved oxidative damage activities(309).
Recent study also suggested that lycopene inhibit bone resorption(310)(311), facilitates bone formation(311) and improved bone mineral density(311) and rat skeletal system in experimental conditions(310).

2. Omega 3 Fatty acid
Omega 3 Fatty acid found abundantly in deep sea fishes, and seeds such flax seed may contribute to the reduced and preventive risk of osteopororsis(312) through intervention of the decreased osteoclastogenesis and loss of bone mass(313). But according to the joint study by Université d'Auvergne, due to fatty acid function in trigger several different independent pathways (receptors, metabolites…), its effects on bone metabolism may require further integrated study(314).

3. Resveratrol
Resveratrol, an powerful antioxidant(315) found abundantly grapes, red and white wine, blueberries,cranberries may have a exclusive impact on bone metabolism due to its effect in reduced oxidative stress by direct interfering with the production of reactive oxygen species (ROS)(316). According to the joint study lead by Fudan University, resveratrol oligomer derivative, isopaucifloral F improved bone mineral density, bone volume/tissue volume, trabecular thickness, trabecular separation/spacing, through its estrogenic effect  may be a promising antioxidant for treatment on postmenopausal osteoporosis(317). Dietary resveratrol also significantly prevented bone loss in the osteoporotic mice, through its effects on reactive oxygen species (ROS), improved the antioxidant/prooxidant equilibrium and balancing the disequilibrium between bone formation and bone resorption(318)in iron load mice study.

4. Silibin 
 Silibin, a major active constituent of silymarin found abundantly in Milk thistle seeds may be beneficiary for patient with osteoporosis due to its effect in promoted bone-forming osteoblastogenesis and encumber osteoclastic bone resorption through accelerated cell proliferation and promoted matrix mineralization, Hallym University suggested(319). In other study, silibin through its osteogenic activity, improves time of bone healing in case of fracture  and bone strength with elevated BMD(320), by stimulating alkaline phosphatase (ALP) activity and calcium nodule formation(320). and promotes osteogenic differentiation of human bone marrow stromal cells(321) throguh bone morphogenetic protein signaling(321)

5. Lignans
Lignans,an phytoestrogen antioxidant found in flax, pumpkin, sunflower, poppy, sesame,etc,..may be a potential sources for ameliorating the post-menopausal osteoporosis as its effects on bone mineral density through significantly decrease in the levels of serum bone turnover markers osteocalcin(322) and alkaline phosphatas(323). According to the recent joint study lead by Jinan University, phytoestrogen ligans significantly promoted osteoblastic cell proliferation and increased osteoblastic
(UMR106)(325)(324) cell numbers of that can induce the bone minera ldensity protective effects(324).
6. The antioxidant enzymes
6.1. Superoxide dismutase
Superoxide dismutase, an antioxidant enzyme used minerals as cofactors and named accordingly such as Cu-Zn-SOD, Cu-SOD, Fe-SOD, Mn-SOD have played an important role in reduced oxidative stress form of osteoporosis(326). According to the Sun Yat-sen University, SOD-1 inhibited reactive oxygen species (ROS),promoted the osteogenic differentiation and Improved osteogenic ability(327) and SOD-2, according to the joint study lead by Chiba University Graduate School of Medicine, induce osteocytes causes of age-related bone loss through rescued the impairment of canalicular networks and bone metabolism(328).
Manganese superoxide dismutase(Mn-SOD), in the study by the joint study lead by The Fourth Military Medical University, improved bone homeostasis by maintaining the balance of osteoblasts (OBs) and osteoclasts (OCs)(329).

6.2. Glutathione peroxidase 
Glutathione peroxidase plays a biological role against oxidative damage may be effective in reduced risk of osteoporosis when usedconjunction with lycopene and other antioxidant enzymes(309). Deterioration of antioxidant enzymes, including glutathione peroxidase, due to aging have found to associate to increased oxidative stress inducing post menopausal osteoporosis(330).

c. Catalase
Catalase like many other antioxidant enzymes found in all living species with a function in reduced damage caused by reactive oxygen species (ROS)(331) may held a keys in preventing the loss of bone mineral density and decreased oxidative stress causes of osteoporotic menopausal women(331).
According to the study by King Abdulaziz University,catalase used conjunction with other antioxidant enzymes and lycopepe showed to suppress bone turnover to restore bone strength(309) of that may reduce risk of bone minerald density loss(309).

The  Phytochemicals
Phytochemicals found in plants, especially on their skins, play an important and biological role in human health protection and against many forms of diseases(333). According to the animal and cellular studies by Royal Botanic Gardens, phytochemicals found in dried plum and citrus and berry fruits and dietary phytochemicals exhibited a positive association of reduced risk of osteoporosis(334) through improved BMD, microarchitecture integrity, and bone strength(334).
1. Flavonoid
 Flavonoid, a group of phytochemicals, including catechin, and the main ingredient of green tea, have found to process certtain anti diseases and health protective effects, including cardiovascular disease (CVD), cancer and diabetes, epidemiologically(335). (-)-Epigallocatechin, epigallocatechin found in Drynariae rhizoma improved bone metabolism, anti-osteoporiotic activities(336) and resorptive action in bone cells(337).through extraction efficacy of polyphenolic compounds in antioxidant activity(336), the Health Care Products Research Laboratories and Dongguk University College of Oriental Medicine(337) suggested.
In deed, the reduction of oxidative stress or chronic low-grade inflammation by phytochemicals such as flavonoids is associated positively between total dietary intake and bone mineral density(338).

2. Phenolics
Phenolics found abundantly in fruits, especially in the skin, including anthocyanins and stilbenoids,.. may be a potential phytochemicals in decreased the imbalance of bone turn over on bone metabolism induced risk of osteoporosis(339). According to the Guangdong Medical College study, phenolics isolated from the 70% ethanol extract of the roots of Livistona chinensis, exhibited anti-osteoporosis effects through reduction of oxidative stress involved bone formation by osteoblastic cells(340) in rat.
In comparison between pre- and postmenopausal women for effectiveness of phenolics from an oleuropein-rich olive (Olea europaea) leaf extract the Safety and Bioactivity of Plant Foods suggested that intake of olive phenolics mayprevent age-related and oxidative stress-related osteoporosis(341),

4. Curcumin
Curcumin a diarylheptanoid of turmeric, is a member of the ginger family (Zingiberaceae) and best known for its antioxidant effects in enhancing the immune system for fighting of the forming of free radicals and foreign invasion of that induced acute and chronic diseases(342). Some researcher has suggested to use curcumin for treatment of various musculoskeletal disorders, such as osteoarthritis, osteoporosis, musculocartilaginous disorders,... due to its efficacy as antioxidant with a significant medicinal properties, such as anti-inflammatory and anti-neoplastic activities(344).
In glucocorticoid-induced osteoporosis, administration of curcumin in dose dependent-manner promote over all bone health by increased BMD and bone-alkaline phosphatase, decreased carboxy-terminal collagen cross links, enhanced bone mechanical strength, and improved trabecular microstructure, according to Shengjing Hospital of China Medical University in rat study(343).
The analytic study of the combination of conjugated GNPs (CGNPs), which can form inclusion complexes with curcumin (CUR-CGNPs) has also found to process a significantly improved bone density and prevented bone loss activities through inhibiting osteoclast (OC) formation and osteoclastogenesis in bone marrow-derived macrophages(345).
 
5. Phloridzin
Phloridzin, another antioxidant found mainly in apple has found to process anti high blood glucose levels and improve lipids metabolism in animal model(346). According to the Unité des Maladies Métaboliques et Micronutriments, in aging induced change of sex hormones related of that lead to inflammatory and oxidant condition, phloridzin prevented imflammatory condition in ovariectomy-induced bone loss, and improved bone resorption(347).

6. Pectin
Pectin, is a structural heteropolysaccharide found mainly in the in the primary cell walls of  terrestrial plants. Pectin Rhamnogalacturonan-Is (RG-Is) isolated from potato and apple may be an important phytochemical in increased osteoprotective effects mediated via antioxidant or anti-inflammatory pathways and their downstream signaling mechanisms(349), such as in increased mineralized matrix formation of osteoblastic cells through production of high amount of galactan in vitro, according to joint study lead by Copenhagen University Hospital Glostrup(348).

Due to proven effects of phytochemicals  in bone health, there is a suggestion in determination of scientist to provide the effective doses of phytochemicals and their metabolites in improving bone mass, microarchitecture integrity, and bone strength of that may reduce the occurrence of osteoporosis(349).

                                The Treatments


A. In conventional medicine perspective
The osteoporosis Canada suggested the following treatment for patient with eosteoporosis depending to differentiation(350).
A.1. Bisphosphonates
1. Including Alendronate (Fosamax), Risedronate (Actonel, Atelvia), Ibandronate (Boniva), Zoledronic acid (Reclast, Zometa), etc..Bisphosphonates are antiresorptive medications widely prescribed for treatment of osteoporosis. The drugs, used most common treatment for osteoporotic patients, regardless to intravenous and oral alendronate administration(351) have shown to significantly reduce the risk of osteoporotic fractures(356). Higher risk patients should be treated bynonbisphosphonate for 10 yr, have a holiday of no more than a year or two(353), but drug holidays should be considered for low-risk patients and in select patients at moderate risk of fracture after 3 to 5 years of therapy(352).
It is suggested that patient under treatment of bisphosphonates therapy should also diet with rich of calcium and vitamin D.

2. Side effects are not limit to
2.1. Nausea
2.2. Abdominal pain
2.3. Difficulty swallowing
2.4. Risk of an inflamed esophagus or esophageal ulcers(354) and Esophageal Cancer(357)
2.5. Fever, myalgias, and arthralgias(357)
2.6.  Musculoskeletal pain(357)
2.7. Hypocalcium(357)
2.8. Risk of sclerosis and a variety of ocular side effects(355)(357)
2.9. Atrial Fibrillation(357)
2.10. Severe Suppression of Bone Turnover(357)
2.11. Subtrochanteric Femoral Fractures

A.2. Hormone therapy
1. Hormone Therapy (HT) or estrogen/progesterone therapy, is commonly used to relieve the symptoms of menopause, especially for women in pre-menopause state with low lower progesterone-to-estrogen level of that induced more negative changes in bone (358). According to the, treatment with estrogen/progesterone in post menopause women showed a protective effect against significant changes in BMD and follow-up BMD(359) against loss of ovarian function due to aging induced increasing risk of osteoporosis(360).
 Estrogen/progesterone therapy with no intention to replace  the loss of these hormones due to post menopause, but to supplement these hormones to the lowest level required to prevent bone loss.

2. Hormone replacement therapy can help to maintain bone density for menopause women, but it increases
2.1. The risk of breast cancer and heart disease(361)
2.2. The risk for venous thromboembolism(362)
2.3. The risk of (Nonmelanoma Skin Cancers) NMSC.(363)
2.4. The risk of stroke(364)
2.5. Other side effects may also include arthralgia and mucosal dryness(365),

A.3. Estrogen replacement therapy
3.1.  Estrogen therapy HT, most used in menopausal women for relieving symptoms such as hot flash, night sweats, mood and sleep disturbances, vaginal dryness and pain with intercourse, insomnia or problems sleeping, frequent urination or urinary incontinence etc.(367).
 Estrogen production in women before menopause plays such an important role in maintaining bone density by balancing the bone turn over through stimulating the calcium absorption and serum vitamin D metabolites against osteoporosis(366). According to the Yale University study, low-dose estrogen therapy may be a better choice for prevention of osteoporosis in menopausal women due to its benefits of significant increased bone mineral density and reductions in markers of bone turnover with no increased risk of endometrial hyperplasia or other side effects(368).

3.2. Adverse effects
Side effects of estrogen replacement therapy are swelling of the ankles and legs, loss of appetite, weight changes, retention of water, nausea, vomiting, abdominal cramps, and feeling of bloatednes(369) and not limit to risk of breast cancer, liver cancer, stroke, gall-bladder disease, thromboembolism(370)(372), cardiovascular disease(371).

A.4. Bone Metabolism Regulator
4.1. Bone Metabolism Regulator including Osteoprotegerin (OPG) are types of human monoclonal antibody medicine used  to prevent RANKL-RANK interaction in bone metabolism through inhibiting osteoclast formation(376)(377), through their effects in reverses osteoporosis(376)(377).
Deficiency of Osteoprotegerin (OPG) reduce function of regulator of postnatal bone mass, decrease in total bone density and induced significant risk of osteoporosis(375).

4.2. Adverse effects of bone metabolism regulator are not limit to pain in the muscles, arms, legs or back and a skin condition with itching, redness and/or dryness. and to the risks of
arterial stiffness(373)(374) and cardiovascular diseases(373) such as atherosclerosis(374)

A.5.  Parathyroid hormone (PTH)
5.1. Parathyroid hormone (PTH) is a hormone released by the parathyroid gland with the function in raising levels of calcium in the blood stream.
In postmenopausal osteoporosis, abaloparatide, a human parathyroid hormone-related peptide analog increased BMD of the lumbar spine, femoral neck, and total hip in a dose-dependent manner, according to the study lead by the Harvard Medical School(378). Once-daily injections of parathyroid hormone have a prominat result in patient with osteoporosis, according to the research team lead by DR. Neer RM., decreased the risk of vertebral and nonvertebral fractures and increased vertebral, femoral, and total-body bone mineral density(379) as well as significantly improved BMD of lumbar spine, total hip, and femoral neck(380).

5.2. Adverse effects are not limit to dizziness, nausea and leg cramps and the risk of hypercalcemia, worsen secondary hyperparathyroidism (SHPT)(381), bone tumors(382).

tomato, grapes, apples, and citrus fruits
1. Skin and seed of grape.
Resveratrol, a phytohemical of skin and seed of grape promoted spontaneous osteogenesis(bone formation) but prevented adipogenesis(adipocytes instorage of fat) in human embryonic stem cell-derived mesenchymal progenitors,
2. 1. Milk thistle seeds

B. In herbal  and traditional Chinese medicine perspective
B.1. Life style modification according herbal and TCM medicine specialist
Life style modification has shown to be beneficiary for patients with osteoarthritis, osteoporosis and rheumatoid arthritis to improve musculoskeletal and bone health and reduce disability, according to the University of Tasmania(383). Modern herbal and TCM medicine specialists may suggest the following
1. Maintain proper weight
Lean women and women with abnormal weight change are found to associate the risk factors and risk of proximal femur bone loss(384).
According to the joint study lead by the David Geffen School of Medicine at University of California, Los Angeles, Postmenopausal weight change such as weight gain, weight loss, and intentional weight loss are associated with increased incidence of fracture, including upper limbs, lower limbs, and central body; hip fracture,...(385). 

2. Physical activity
Exercise, today is less popular leisure-time activity in many countries throughout the Western world, especially in the youth due to promotion of information collection through mobile phone. According to study, moderate exercise, has found to prevent and ameliorated the risk of osteoporosis(389). A physically active women has found to associate to reduce risk of osteoporosis (384) in compared with physically inactive women(386). According to the Federal University of São Paulo, physical exercise is an important stimulus for osteoporosis, as it improves bone microarchitecture, bone density and bone strength, as well as increasing physical function(387), through the stimulation of bone tissue, muscle strength and muscle contraction(387).
6-month whole body vibration training, in older women reduced risk factors for falls and fractures, the Faculteit Lichamelijke Opvoeding en Kinesitherapie suggested(388).

Exercise training showed to  reduce bone turnover, improve hip bonemineral density despite decline in bone-active hormones in in obese hormone decreased aging adults(390).

3. Stop smoking
Smoking, a behavioural risk factor has long been known for its negative effects on over health, causing 3.3 billions pounds of unnecessary burden to the health care systemon UK alone(428).
The 2003/2004 South African Demographic and Health Survey, suggested that smoking is positively associated with osteoporosis and lifetime use of both snuff and cigarettes may increase risk osteoporosis among women who are 40 years and older(429). DR. Kim KH, and the research team at the Seoul National University College of Medicine in the study of second hand smoke said " postmenopausal never-smoking Korean women, exposure to SHS was positively associated with osteoporosis". Postmenopausal Women who are exposured to SMS are found to associate to increased occurrences for lumbar and femoral neck osteoporosis if hercohabitant smokers consumed ≥20 cigarettes/day(430). 
In fact, the researchers at the Catholic University of Korea in the study of smoking relationship between smoking and bone mineral density (BMD) showed that urinary cotinine level is directly related to the BMD at femur neck, total femur, and lumbar spine among postmenopausal females in dose depend-manner(431).

4. Alcoholism
Moderate alcohol drinking has long been associated to over all health and longevity. In dose depent-manner, alcohol intake among menopausal women are highly significant correlated with osteoporosis, causing the quantity and quality of BMD declines gradually or even rapidly(432). A radiographic survey of 96 fully ambulatory male patient with chronic alcoholism between age ranged from 24 to 62 year showed that osteoporosis is found in most of the patient regardless of age. Bone loss has also found in patient relatively young from age 31 to 45 years(427).
The joint study lead by State University of Sao Paulo also insisted that chronic alcoholism may affect bones in general through induced apoptosis of osteoblasts and osteocytes and bone cells(433).


B.2. Diet modification according herbal and TCM medicine specialist
1. Top foods to reduce risk of inflammation
Epidemiological studiesin human and animal have insisted of pro-inflammatory cytokines as primary mediators of the accelerated bone loss at menopause in which interfering the activation of osteoclasts and stimulators of osteoclastic bone resorption(391).
According to the study lead by the St Vincent's University Hospital Dublin, osteoporosis is found to associate to abnormal bone turnover, systemic inflammation and ultimately increased bone loss and fractures(392)
Dr. Jakob F. and research team at the Universität Würzburg said "....impaired inosteoporosis and during aging. Bone resorption is enhanced by chronic inflammation while bone formation is altered by rising levels of inhibitors in the aging organism,.."(393)

1. 1. Garlic
Garlic, one of the top food with property on modulation of the pro-inflammatory cytokines associated to postmenopausal bone loss(394) due to aging in reduced production of estrogen. The recent study by the Presidency College, suggested that oil extract of garlic promotes and preserve skeletal health in attenuate bone loss by expression of estrogenic effects through reduced oxidative stress of peritoneal macrophages, lymphocytes and serum interleukins(395) and enhanced intestinal transference of calcium(396).
In ovariectomized rat model, garlic oil in comparison with lovastatin exhibited anti bone loss its reflected onhigher bone densities and higher bone mineral contents(397) as well as induced positively in suppressing ovariectomy-bone resorption(398)..

1.2. Turmeric
Turmeric with the similar property as garlic in enhancing immune system fighting against inflammation caused by either free radicals and foreign invasion(399)(400). Used in tradition medicine to relieve menopausal symptoms, the antioxidant also promoted production of bone structural genes, increased the osteoprotegerin to RANKL ratio and supported mineralization more efficiently, according to the Mahidol University(401), as well as reduced trabecular bone loss and prevented deterioration of bone microarchitecture by suppressing the rate of bone turnover(402) probably due to its phytoestrogenic effects(401). DR. Shishodia S and the research team at the The University of Texas M. D. Anderson Cancer Center said " The efficacy, pharmacologic safety, and cost effectiveness of curcuminoids prompt us to "get back to our roots.""(403) due to its effects for treatment of several diseases(403).

1.3. Green tea
Green tea, a precious drink in traditional Chinese culture and used exceptional in socialization for more than 4000 thousand years, is considered as one the top antioxidants and anti inflammatory agent (404)(405). Epidemiological studies suggested that green tea benefited body composition and improved bone microstructure and strength(406), exhibited osteogenic differentiation(407) and reduced risk of osteoporosis(408).

1.4. Shiitake mushrooms
Shiitake mushroom is an edible mushroom with anti inflammatory activity through activated the immune effects and enhance cell resistance to bacterial infections(409).
According to the study by the College of Veterinary Medicine, D3 found in mushroom improved osteoporosis-like symptoms through it effects on improved bone mineralization by inducing the expression of calcium-absorbing genes found in the duodenum and kidney(410).

1.5. Onion
Onion, with the same properties as of garlic, also consisted the anti osteoporosis property through its effects on increased bone density in perimenopausal and postmenopausal women 50 years and older(411). The Universitätsspital/Inselspital Bern. on the expression of Osteoporosis diet suggested that intake of vegetables from onion family inhibits bone resorption in a dose-dependent manner(412). Dr. Tang CH and the research team at the China Medical University said "water solution of onion crude powder inhibits osteoclastogenesis from co-cultures of bone marrow stromal cells and macrophage cells via attenuation of RANKL-induced ERK, p38 and NF-kappaB activation"(413).

2. Cold water fish Salmon
Salmon is the common name for Salmonidae. They are anadromous, born in fresh water, migrate to the ocean, then travel thousands of miles in the deep sea cold water throughout their life cycle and within to five years returning to the exacted location where they were born to reproduce and die.

Nutrients
1. Protein
2. Omega-3 fatty acids
3. B vitamins
4. Vitamin D
5. Astaxanthin
is a potent antioxidant that stimulates the development of healthy fish nervous systems and enhances the fish's fertility and growth rate.
6. Selenium
7. Tryptophan
8. Magnesium
9. Phosphorus
10. Etc.

Intake of salmon calcitonin, a hormone produced by the thyroid gland of salmon or a synthetic polypeptide of the same sequence found in salmon(360,415) has shown to reduce vertebral crush fractures and bone pain and considered for prevention and treatment of postmenopausal osteoporosis(416). In a randomized trial of  men with idiopathic osteoporosis, nasal spray salmon calcitonin exhibited a significantly pronounced suppression of bone resorption markers by increasing lumbar BMD and reducing bone turnover in men with idiopathic osteoporosis(417) and affecting serum and synovial fluid bone formation and resorption markers in osteoporosis patients(418). Dr Dexue L and Dr. Yueyue Z. said" salmon calcitonin of 50 IU each time, subcutaneous injection 1 time every 3 days, for 3 months is a reasonable solution may be effective for treatment of elderly women with type 2 diabetes and osteoporosis"(419).
Further more, in a randomized, placebo-controlled trial, treatment with salmon calcitonin increased lumbar spine BMD and improved low bone mass and reduced fracture risk in postmenopausal women(420).
The high amount of Omega 3 fatty acid also make salmon of the dietary nutrients for skeleton health including prevention reduced risk of progression of osteoporosis(421).

3. Nuts and seeds Olive
Olive is belongs to the the family Oleaceae, native to the coastal areas of the eastern Mediterranean Basin and south end of the Caspian Sea. Its fruit, is also called the olive and the source of olive oil.

Olive Oil: Fat Content
1. Saturated fats
a. Palmitic acid
b. Stearic acid
c. Arachidic acid
d. ehenic acid
e. Myristic acid
f. Lignoceric acid
2. Unsaturated fat3. Monounsaturated fats
a. Oleic acid
b. Palmitoleic acid
3. Polyunsaturated fats
a. Linoleic acid
b. Linolenic acid

Monounsaturated fatty acids found abundantly in olive oil, has found to regulate adipose tissue inflammation by altering adipocyte signalling pathways and the secretion of proinflammatory cytokines(422) of that may induced risk of osteoporosis as mentioned.
The richest source of oleoyl serin of olive oil may contribute to lowered prevalence of osteoporosis if consumed in high amount, Dr Bradshaw HB and Leishman E. suggested(423).
In vertebra and tibia in ovariectomized rats, black olive hydroalcoholic extract effectively lower the quantitative changes of the bone structure and prevented bone loss in this osteoporosis animal model, through decreased osteoclast cells in vertebra and tibia(424) and increased in the cortical bone thickness (CBT) and the trabecular bone thickness (TBT)(425).
In deed, according to the study by the Xiamen University, the effectiveness of olive oil in exhibition of anti-osteoporosis is due to its function in significantly increased BMD and decreased phosphatase, alkaline phosphatase, IL-6, MDA, and nitrate levels(426).

4. The Preventive foods
4.1. Dry plum
Dry plum is best known for its natural laxative sorbitol used for treatment of constipation and considered as a best candidate for treatment against osteoporosis and osteopenia due to the presence of antioxidants hydroxycinnamic acids(434) and anthocyanins(435).
Some studies of the bone-protective properties of dried plum suggested that the fruit significantly increased the BMD of the ulna and spine through its antioxidant effects on increased RANKL and osteoprotegerin (OPG) levels in comparison with the control group(436). In postmenopausal women, daily intake of dried plum (100 g/d) significantly increased BMD of ulna and spine through suppressed rate of bone turn over in comparison with the same intake as of apple(437), according to
the Florida State University
Dr. Hooshmand S. and the research team at the San Diego State University and Florida State University suggested ".... the positive effects of dried plum on bone are in part due to the suppression of RANKL production, the promotion of OPG and the inhibition of sclerostin..." of that have a direct control on bone formation via the production of sclerostin and bone resorption(438).

4.2. Apple
Apple, one of the most widely cultivated tree fruit for its nutrients, is the pomaceous fruit of the apple tree, a species of the rose family Rosaceae, originated in Central Asia. The fruit has long been known for its benefits in cardiovascular protective effects(439).  Dihydrochalcone phloretin, an antioxidant found in apple tree leaves, exert protective effect against estrogen deficiency-induced osteoclastogenic resorption, through its activities involved RANKL-differentiatiation in mature osteoclasts(440). According to Unité des Maladies Métaboliques et Micronutriments, phloridzin, an other apple antioxidant polyphenol improved aging and sex hormones deficiency causes of inflammatory and oxidant conditions, inducing pathogenesis of osteoporosis, through promoting inflammation markers and bone resorption(441).

4.3. Tomato
Tomato is a red, edible fruit, genus Solanum, belongs to family Solanaceae, native to South America. Because of the recent discovery of its antioxidant, such as lycopene in reduced risk of prostate(442) and cancers(443) and cardiovascular disease(443), tomato is grown world wide for commercial purpose and often in green house.
Dr. Sołtysiak P and Dr. Folwarczna J. in the assessement of the effectiveness of carotenoid pigment, lycopene suggested that the phytochemical exhibit a favorable affect the skeletal system such as osseous tissue through inhibited bone resorption(444), the formation of ROS-secreting osteoclasts(445), formation of tartrate-resistant acid phosphatase  + multinucleated osteoclasts(445) of that can result in reduced risk of osteoporosis.
In animal model, lycopene decreased oxidative stress of which has a inversely correlated with BMD and improved BMD through facilitated bone formation and inhibited bone resorption(446).

4.4. Dairy and calcium fortified products
Intake regularly of Dairy(The prevention and management: the Diet-1) and calcium fortified products(The prevention and management: the Diet-5) are both recommended by herbal medicine  for its benefits in induced calcium absorption because of the presence of vitamin D3, but not in traditional Chinese medicine. TCM views dairy products with a extreme dampness presentation(446a) of which induce production of phlegm(446b) causes of many forms of diseases.


5. The Supplements for osteoporosis
5.1. Phyto-estrogens(women only)
Phyto-estrogens found in plants weaker types of estrogen hormone with estrogenic or/and antiestrogenic effects in comparison to natural estrogen hormones(447). In perimenopausal or postmenopausal womenwomen intake of phytoestrogen is found to associate to vasomotor symptoms relief(448). Genistein, one of the best known phytoestrogen exhibited anti-resorptive effects on bone metabolism, anti bone loss by enhanced osteoblastic production of osteoprotegerin (OPG)(450).
Dr. Malinova M. said" phytoetrogens and vitamin D administered in a dose-dependent manner effectively prevents bone loss in postmenopausal women and reduces the incidence of fractures"(449). In fact, the effects of phytochemical in reduced risk of osteoporosis may also be depended on genetic influence.  According to the Nanchang University, the effects of dietary phytoestrogens on bone mineral density (BMD)postmenopausal women may be varied with ERα gene(451).

5.2. Glucosamine
Glucosamine, a compound of the simple sugar glucose and the amino acid glutamine, is a precursor for glycosaminoglycans(194,452), a major component of joint cartilage(195,453). As a Collagen peptides, glucosamine has produced a favorable effect on bone health and cartilage tissue(454).
According to the study by the Queen's University, oral administration of glucosamine at 200-mg/kg dose for 6 months showed a significant preventive effects on mineral content and some biomechanical properties(455) of which improve bone and joint disorder. Dr. Anastassiades T and the research team said" N-butyryl glucosamine (GlcNBu) can be positioned between nutriceuticals and pharmaceuticals for the prevention and treatment of osteoporosis"(455).
In senescence-accelerated OXYS rats as model of osteoporosis, glucosamine alendronate (GA) alone or/and icombination with dihydroquercetin (DHQ) increased BMD and the level of osteocalcin, according to the study by Institute of Cytology & Genetics of the Siberian Branch of Russian Academy of Sciences(456)
 In deed, treatment of glucosamine sulfate, chondroitin sulfate, hyaluronic acid, collagen hydrolysate, or nutrients, such as antioxidants and omega-3 fatty acids showed to prevent cartilage degeneration in patient with bone and joint disorder , according to study(195, 457).

5.3. Chondroitin
Sulfated glycosaminoglycan (GAG), found in cartilage around joints in the body is a chemical composed of alternating sugars (N-acetylgalactosamine and glucuronic acid).
Chondroitin sulfate (CS), a glycosaminoglycan (GAG) and functional component in proteoglycans of cartilaginous tissues may be a nutraceutical ingredient commonly utilized in fighting against arthritis, osteoarthrosis, and sometimes osteoporosis(458), probably through activation of Cathepsin K (CatK), a major lysosomal collagenase produced by osteoclasts, in bone resorption.and promoted efficient collagen degradation(459). Given all the positive information of Cathepisn K in bone health, Dr. Li Z and the research team said" targeting cathepsin K complex formation would be an effective and specific treatment for diseases with excessive bone resorption such as osteoporosis'(460).
Dr. Watanabe R and Okazaki R. said" Cathepsin K,.....markedly reduced bone resorption with a transient reduction in bone formation, thus resulted in a robust increase in both trabecular and cortical BMD in osteoporotics"(461).

7. Natural treatment 
Beside suggesting certain herbal medicine for treatment of osteoarthritis, modern herbal and TCM medicine doctors may also combine other natural treatment for alleviating symptoms of the disease
1.  Electrostimulation
Use of electricity for treatment of pain, muscle dysfunction and sarcopenia can be dated back to Ancient Egyptians and later the Greeks and Romans(421,462).
In a variectomized rat study, application of pulsed electric field exposure reduced the effect of osteoporosis and restore the bone loss(463). Dr. Manjhi J. and the research team at the Jawaharlal Nehru University, said" In in CCPEF bones, there was an attenuation of decrement in the noted parameters(significant decrease in BMC, BMD, calcium, and phosphorus contents) except phosphorus" probably through stimulation of osteogenesis(465) of that may attenuate the effects of the ovariectomy-induced bone mineral loss in rats(464) and enhance higher global bone mineral content(465).

2. Use Ice or Heat Therapies therapy
Ice therapy such as repeated, rather than continuous, ice applications may be considered as an effective treatment for some patient with pain in osteoporosis due to fracture, a series of compression fractures, muscle spasm and chronic back pain, according to the recommendation by the Osteoporosis: Coping With Chronic Pain by National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center(466).
Dr. Mediati RD and the research team at the Palliative Care and Pain Therapy Unit, said "osteoporotic acute pain may be reduced if ".... in cases of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations that seems to contribute in significant way in causing irreversible pain chronic syndromes"(467).

3. Acupuncture
The most oldest form of medical treatment in traditional Chinese medicine has been known for its function in relief pain(383,468) and functional limitation(384,469) for chronic patient, including patient with moderate or severe chronic knee pain(383,468), peripheral joint osteoarthritis(384,469) and hip osteoarthritis(470).
A twenty-four 8-week-old female Sprague-Dawley rats study conducted by Suzuka University of Medical Science, 16 weeks of treatment of acupuncture not only promoted the bone formation but also suppressed the bone resorption of which may be useful for treatment of menopausal osteoporotic women(471). Dr, Ma J and the research team said " acupuncture can suppress abnormal increase of body weight and decrease of serum E2 level, and significantly downregulate serum of alkaline phosphatase, bone gla protein and tartrate-resistant acid phosphatase levels in OVX rats, which may contribute to its effect in relieving osteoporosis"(472).
Other study also promotes the use of electroacupuncture (EA) for treatment of osteoporosis not only for it effects as mention in (472) but also improve the level of E2 and propeptide of type I procollagen (PICP) significantly(473).

3. Massage Therapy
Massage therapy has been used in traditional Chinese medicine over thousands of year for treatment of chronic and acute pain in osteoporostic patient due to fractures and fracture related conditions(474).
Comprehensive therapy including massage therapy has shoen to improve the bone metabolism, clinical symptoms and the activity function of joints, and elevate serum SPARC levels in patient with osteoporosis, according to the Shanghai East Hospital Affiliated to Tongji University(475).
Unfortunately, the The Third Hospital of Hebei Medical University reported a case of a pedicle fracture after a back massage, therefore, this event may raise awareness of awareness of a complication of alternative medicine(476).
Dr. Uhlemann C and Dr. Lange U. said" Physical therapy applied in osteoporosis includes ......  mechanical (massage, physiotherapy) stimuli, which can be applied regionally, locally or holistically"(477)(for pain relief).

4. Spa therapy
Spa therapy may be one the effective technique for treatment of lower back pain, according to some studies(392, 478). The spa therapy conducted by Santa Maria de is Acquas, suggested that long-term mud-bath therapy (MBT) showed a reduced frequency of osteopenia and osteoporosis and benefit for the BMD of menopausal women(479).
In pain relief, spa therapy showed to relief symptoms of pain, stiffness and mobility(395,480), improve physical function and quality of life(397, 481) in patient with OA.

5. Hydro exercise therapy
Hydrotherapy, using water for the treatment of disease has shown some beneficiary for treating pain in patient with lower back pain(399,482), joint hemorrhages(400,483) and multiple sclerosis(401,484). The study of 35 postmenopausal women trained for seven months for three one-hour sessions per week suggested that water exercise exhibit a positive effects in maintenance and improvement of bone status(485).
In a randomized Clinical Trial of Aquatic versus Land Exercise, conducted by the University of Saskatchewan, researchers showed that aquatic exercise Significant improvements in balance and may be considered as a viable alternative for older women with OP who have difficulty exercising on land(486).
In deed, the 152 older persons with chronic symptomatic hip or knee OA study by the University of Sydney, hydrotherapy or Tai Chi classes expressed the enhancement of large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA(403,487) for pain relief.
6. Tai Chi
Tai chi, an ancient form of mind-body exercise or technique used in Chinese with meditative movements that promote balance and healing of the mind and body induced mental concentration, physical balance, muscle relaxation, and relaxed breathing(406,488) and beneficial effects with respect to balance, falls and non-vertebral fractures(489).
The Universität Würzburg, in the study of effects of aging on osteoporosis, suggested that Tai Chi, suitable to patient with osteoporosis may be a better form of disease-adapted exercise to reduce fracture risk, improve quality of life, maintain independence and decrease mortality(490).Dr. Kozaki K, in the study of  the Cochrane systematic review article 2009 said " exercise such as Tai-Chi, ............ are shown to prevent falls in community-dwelling elderly"(491).
In fact other study such as combination of Green tea polyphenols (GTP) and Tai Chi(TC) improve osteoporotic degenerative bone health by effectively reduced the levels of oxidative stress in postmenopausal women with osteopenia (492)

7. Yoga
An ancient form of medical technique originated from India, is become a popular multimodal mind-body exercise in the Western world for promoted flexibility, strength, endurance, and balance(412,493).
Practice of yoga, according to Dr.Smith EN, and Dr. Boser A. is found to provide a greatest benefit to individuals with osteoporosis such as prevented or ceased the progression of osteoporosis, strengthened the muscles supporting the spinal column, promoted balance, improved posture, and enhanced quality of life with least risk(494), especially not for spinal flexion exercise (SFE) in patients with spinal osteoporosis(495).
Further more, the Istanbul University study insisted that yoga may be an alternative physical activity potentially for a positive effect on pain, physical functions, social functions in the rehabilitation of osteoporotic menopausal women(496).


8. Chiropractic
 Chiropractic is one the alternative therapy for diagnosis and treatment of Musculoskeletal disorders (MSDs), including lower back pain with osteoporotic patient(497).
According to the joint study by the Dartmouth Institute for Health Policy and Clinical Practice and Southern California University of Health Sciences,chiropractic spinal manipulation may lower 76% risk of injury to the head, neck, or trunk within 7 days among subjects with a chiropractic office visit in patient of aged 66 to 99 years(498).
In the treatment of a 74-year-old man presented with low back pain (LBP) and loss of feeling in his lower extremities for 3 months, Dr. Roberts JA and Dr. Wolfe TM. said" Chiropractic management...activator-assisted spinal manipulative therapy, had positive subjective and objective results for LBP and ambulation in a geriatric veteran with degenerative disk disease and diffuse idiopathic skeletal hyperostosis"(499).

B.2. Herbal and Traditional Chinese medicine 
Herbal medicine have been used effectively over thousand of years for treatment of osteoporosis. Many individual and formulas herbal medicine with anti-osteoporotic effects in traditional Chinese formulas, have gone through clinical trials and in vivo animal studies, especially in theirs bioactive constituents(500)(503).
B.2.1. Individual herb
1. Milk thistles
Milk thistles,the genus Silybum Adans, belonging to the family Asteraceae, native to the Mediterranean may be the next potential herbal medicine for treatment of osteoporosis due to the presence of clinical studies and scientific evidence of phytochemicals silibinin(501). According to the  Universiti Kebangsaan Malaysia study, silymarin found in milk thistles exhibited the properties of prevention of bone loss and regulation of osteogenesis(504) of that reduce bone mineral density loss and fracture in post menopausal women, probably through its antioxidant and estrogenic effects(502) via multiple signal pathways(504).
Other study also suggested that milk thistle (Silybum marianum) mixture of flavonolignans extracted, promoted accelerated cell proliferation and matrix mineralization through enhancing bone nodule formation by calcium deposits. In addition, the mixture is found to induce osteoblastogenic biomarkers of alkaline phosphatase, collagen type 1, connective tissue growth factor, and bone morphogenetic protein-2(505),

2. Piper sarmentosum
Piper sarmentosum found in many Southeast Asian cuisines and used for used treatment of many diseases such as inflammation, dermatitis and joint pain, may be the next generation herbal medicine for treatment of osteoporosis(509), probably through it estrogenic effects(506).
In glucocorticoid-induced osteoporosis male Sprague-Dawley rats study, Piper sarmentosum (Ps) promote bone minerals density through inhibited 11βHSD1, the enzyme plays an important role to effects the function of glucocorticoid action in bone, in liver and adipose tissue, regulated corticosteroids and reduced bone resorption markers(507).
According to the study by the Universiti Kebangsaan Malaysia, administration of water extract of piper sarmentosum in animal model, improved significantly in bone fracture healing(509) in estrogen deficient Sprague-Dawley rats(508).

3. Black Cohosh
Black cohosh, one of the best known herbal medicine with weak phytoestrogenic expression used for alleviating symptoms of menopause(510) may be emerged as a potential anti osteoporotic agent for treatment of estrogenic deficiency menopausal women.
Actein, isolated from black cohosh is found to consist a stimulatory effect on osteoblastic bone formation, throigh its expression of significant elevation of alkaline phosphatase activity, collagen synthesis, osteocalcin production, mineralization, and glutathione content in the cells, according to the Kyung Hee University(511). Remifemin, an isopropanolic extract of black cohosh prevented bone density loss in the distal end of the femur and preserved the trabecular bone structure in both the lumbar vertebra and distal end of the femur in 120 female Sprague-Dawley rats model(512).
The University Medical Center Göttingen study also supported the use of black cohosh for treatment of osteoporosis due to the efficacy of non estrogenic fraction, triterpene-saponin-fraction of the herb in reduced the development of osteoporosis through reduction of the bone marrow fat load and possibly by reducing the secretion of pro-inflammatory cytokines(513).

4. Labisia pumila (Kacip Fatimah)
Labisia pumila (Kacip Fatimah), a malaysian herbal medicine in the Primulaceae family of used for treatment of relieving menopausal symptoms due to its estrogenic effects(514). Through its phytoestrogenic, antioxidative and anti-inflammatory effects, the herbal medicine may be a potential replacement for hormone therapy for menopausal women in treatment of osteoporosis by directed influence on connectivity density, trabecular bone volume, trabecular thickness, trabecular separation and trabecular number(515).
In postmenopausal osteoporosis rat model, intake of herbal labisia pumila promote in bone strength parameters such as maximum load, displacement, stiffness, stress, and Young Modulus, according to the Universiti Kebangsaan Malaysia(516).
Furthermore, Dr. Fathilah SN and the research team at the National University of Malaysia-Universiti Kebangsaan Malaysia said"LP(Labisia pumila) has potential as an alternative to Estrogen Replacement Therapy (ERT) for prevention of postmenopausal osteoporosis"(517)

5. Eurycoma longifolia (Tongkat Ali)
Eurycoma longifolia belongs to the family Simaroubaceae, is a Malaysian herbal medicine used for treatment of sexual dysfunction(518) and performance(519) through its phytoandrogenic properties(520). In androgen- deficient osteoporosis rat model, eurycoma longifolia (EL) protect against bone calcium loss and bone mineral density through its effects in elevated the testosterone levels, reduced the bone resorption marker and upregulated Osteoprotegerin (OPG) gene expression(521) of that may be used for treatment of osteoporosis in elderly men(522).
Dr. George A and Dr. Henkel R. said" Eurycoma longifolia (Tongkat Ali; TA) is natural alternative to TRT and has been shown to restore serum testosterone levels, thus significantly improving sexual health. This includes significant positive effects on bone health and physical condition of patients"(523).

6Radix Dipsaci
Radix Dipsaci also known as Xu Duan, is a slightly fragrant, bitter, slightly sweet and slightly astringent used for treatment of weak tendons and bones due to liver and kidney deficiency.
According to the study by University of Hong Kong, crude extract from Radix Dipsaci, intake of the herb induced 4.50% increase in bone volume/tissue volume ratio, 11.82% in bone trabeculae(524).
Total saponins (RTS), primary active components of Radix Dipsaci not only showed to reduce the risk of bone fractures but also increased alkaline phosphatase activity, osteocalcin levels and the degree of mineralization in MC3T3‑E1 mouse osteoblast precursor cell, according to the jopint study lead by Northwestern Polytechnical University(525).Furthermore, Radix Dipsaci (RDD) on osteoporotic rats induced by ovariectomy (OVX). increased bone formation by stimulating overexpression of OPG and downregulation of RANKL in osteoblasts (OB) and bone marrow stromal cells(526).

7. Yin Yang Huo
Yin Yang Huo is also known as Horny Goat Weed used in traditional Chinese medicine for treatment of testosterone deficiency causes of sexual dysfunction and sexual desire and bone formation...(527). According to the Diabetes Research Center Beijing University of Chinese Medicine Beijing, Herba Epimedii (HEP) containing many individual compounds with functions of anti-resorptive and bone formation-stimulating effects, which target different pathways in the bone remodeling cycle(528) and can be employed as an integrative therapeutic approach to treat complex diseases such as osteoporosis diseases(528).
Dr. Bian Q. and the research team at Fudan University said" traditional Chinese herbal drugs with the effect of tonifying the kidney (such as yin yang huo) may promote bone marrow stromal cells (BMSCs) to differentiate into osteoblasts by regulating BMSCs cycles and cell metabolism, and show therapeutic effect on osteoporosis"(529).

8. Red sage (Salvia miltiorrhiza Bunge)
Red sage also known as Dan Shen with the pharmaceutical name of Radix Salvia miltiorrhizae, is a bitter and slightly cold herb, used mainly in traditional Chinese medicine for tonifying blood(494,530), such as getting rid of clot blood, invigorate blood, breakup blood stasis,... through its effects on liver and heart meridians. According to the joint study lead by the Beijing University of Chinese Medicine, in the review of over 130 research papers, herbal Dan Shen and its chemical constituents including tanshinone I, tanshinone IIA, cryptotanshinone, and dihydrotanshinone(532) display anti-resorptive and bone formation-stimulating features targeting different pathways in the bone remodeling cycle, such as the activation of osteoblasts, the modulation of osteoclastogenesis, and the inhibition of collagen degradation by cathepsin K"(531).

9. Fructus Ligustri Lucidi
As an a well-known invigorator, Fructus Ligustri Lucidi has been used in traditional Chinese medicine for treatment of age related diseases, including anti-osteoporotic activity(533). Using alone, the herbal medicine water extract exhibited anti bone mineral loss action against hypercalciuria and trabecular bone deterioration in experimentally type 1 diabetic mice(534). Combined with other such as Herba Epimedii, Fructus Ligustri Lucidi induced increased the bone mass and the contents of calcium and phosphorus in the bone mineral, strenghtened the biomechanical properties, and attenuated bone turnover through stimulating bone resorption and collagen metabolism, according to the joint study lead by the School of Traditional Chinese Medicine(535).
Other study insisted that the combination extracts of Herba Epimedii and Fructus Ligustri Lucidi might be beneficial as an alternative medicine for the prevention and treatment of osteoporosis due to its effects on sex hormone functional levels(536)

10. Du-Zhong (Eucommia ulmoides Oliv.)
Du-Zhong, one of leading herb used in traditional Chinese medicine for tonified kidney for treatment of bone fractures and joint diseases showed to improve bone biomechanical quality through modifications of BMD, and trabecular microarchitecture in ovariectomy (OVX) rat model(537). 
Total lignans, major chemical constituents found in barks of Du-Zhong, may be used for treatment of osteoporotic menopausal women due to the effects of induced primary osteoblastic cell proliferation and differentiation, inhibition of osteoclastogenesis through an increase in osteoprotegrin, according to the joint study lead by Fourth Military Medical University(538). Dr. He X., and the research team of the study of ethnopharmacology, phytochemistry and pharmacology of an important traditional Chinese medicine of Du-Zhong said" Eucommia ulmoides(Du-Zhong) has been used as a source of traditional medicine and as a beneficial health food... because of its possession of wide-ranging pharmacological actions", including osteoporosis(539).

11. Fructus psoraleaeFructus psoraleae, widely used in Asian traditional Chinese and folk medicine for the treatment of vitiligo, bone fracture and osteoporosis, probably due to its potency in stimuled osteoblasts proliferation and differentiation,... throguh its phytochemicals Bavachin and isobavachin(540). The Chinese University of Hong Kong study of osteoporotic effects on formula containing Fructus Psoraleae suggested that the formula may be a potential medicine for treatment of osteoporosis as a result of its effect in prevented mast cell accumulation in contribution to the pathogenesis of osteoporosis(541).
Because of its tonifying kidney property, according to the China Academy of Chinese Medical Sciences, fructus Psoraleae as well as other herbal medicine in the QiBaoMeiRan formula (QBMR) may be effective for treatment of osteoporosis induced by estrogenic deficiency(542).


B.2.2.The formulas
1. Taikong Yangxin Prescription
Taikong Yangxin Prescription, Containing 10 Chinese herbs(543), in male Sprague-Dawley rats model, the herbal formula express favorably in significant protective effect against bone loss through increases of the trabecular BMD, bonevolume fraction, trabecular number and thickness(543).
No other studies have been found for this formula.

2. QiBaoMeiRan Wan
The herbal formula is a composition of 7 herbs including Shou Wu, Fu Ling, Niu Xi, Dang Gui, Gou Qi Zi, Bu Gu Zhi and Hei Zhi Ma(546) used in traditional Chinese medicine for nourished kidney yin and tonified blood(545) in menopausal women of that may be a leading canadate for treatment of osteoporosis as a result of etrogenic deficiency(545).  In ovariectomized rat model, QiBaoMeiRan Wan exhibited anti osteoporotic protective effects through increase in serum alkaline phosphatase, bone Gla-protein and C-telopeptide fragments of type I collagen and decreased the decline of serum calcium and phosphorus in the circulation, the China Academy of Chinese Medical Sciences suggested(544).

3. Bu-Shen-Ning-Xin Decoction
Bu-Shen-Ning-Xin Decoction, is a composition of herbal medicine for treatment of osteoporosis in menopausal women(547), through its anti  estrogenic deprivation effects. According to the joint study lead by the Fudan University Shanghai Medical College, administration of the decoration exhibited inhibitory effects on osteoclast differentiation and bone resorption through suppressed RANKL-induced NF-κB transcription(548) via selective estrogenic receptors.
Dr. Gui Y and the research team at the Fudan University showed that oral administration of Bu-Shen-Ning-Xin decoction (BSNXD)in rat model increased DHEA and inhibited RANKL-induced osteoclastogenesis in vitro in a dose-dependent manner(549).

4. Xianlinggubao prescription
The herbal formula is a register prescription of traditional Chinese medicine for prevention and treatment of osteoporosis with some identified compound, including phenylpropanoids have found to reduced bone loss through the effects on bone mass, bone microarchitecture, bone strength and bone turnover markers(550). According to the The Chinese University of Hong Kong, Xianlinggubao (XLGB) improved bone density, microarchitecture, and mechanical strength,... through its estrogenic  action in anti deterioration of musculoskeletal tissues(551).
5. Er-Xian Decoction
Er-Xian Decoration is a herbal composition containing Xian Mao, Yin Yang Huo, Ba Ji Tian, Dang Gui, Huang Bo and Zhi Mu used in traditional Chinese medicine for treatment of menopausal symptoms(552) and estrogenic deficient osteoporosis(553) through partially the ER signaling pathway(553). According to the study by the Second Military Medical University, Er-Xian decoction (EXD) not only exhibited a protective effect against bone loss in ovariectomized osteoporotic rats through inhibitory effects on osteoclastic bone resorption but also improved the ratio of protein expression of osteoprotegerin (OPG) and RANKL in osteoblasts(554) through its interaction of phytochemicals effects oficariin, curculigoside, and berberine(554).
Combination with epimedium herbs, and icariin also expressed the anti osteoporotic activity through emulated estrogen and improved bone density and architecture, the Second Military Medical University suggested (555).

6. Liu Wei Di Huang Wan
The herbal formula is a composition of  Shu Di Huang, Shan Zhu Yu, Mu Dan Pi, Shan Yao, Fu Ling and Ze Xie used in traditional Chinese medicine for treatment of varies diseases with kidney and liver yin deficiency. The formula may also be used for postmenopausal osteoporosis (PO) due to its phytochemicals orroniside and loganin activities in improved the activity of alkaline phosphatase (ALP), and increased the contents of collagen type I and osteocalcin, Dr. Li M and the research team at the Heilongjiang University of Chinese Medicine suggested(557).
In  a 8-week-old female Sprague-Dawley (SD) ovariectomy (OVX) rat, intragastric administration improve bone density through significantly decrease the serum level of alkaline phosphatase (ALP), osteocalcin (BGP) in serum(556).

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(125) Serum levels of insulin-like growth factor (IGF); IGF-binding proteins-3, -4, and -5; and their relationships to bone mineral density and the risk of vertebral fractures in postmenopausal women by Yamaguchi T1, Kanatani M, Yamauchi M, Kaji H, Sugishita T, Baylink DJ, Mohan S, Chihara K, Sugimoto T.(PubMed)
(126) [Osteoporosis treatment for patients with chronic kidney disease].[Article in Japanese] by Konishi Y.(PubMed)
(127) Identification of Osteoporosis & Chronic Inflammatory Rheumatic Disease In French Claims Data. by Belhassen M1, Levy-Bachelot L2, Laforest L1, Ginoux M1, van Ganse E1.(PubMed)
(128) Aging, chronic illness and self-concept: a study of women with osteoporosis by Wilkins S1.(PubMed)
(129) The chronic obstructive pulmonary disease comorbidity spectrum in Japan differs from that in western countries by Takahashi S1, Betsuyaku T2.(PubMed)
(130) Osteopenia and osteoporosis in women with breast cancer by Ramaswamy B1, Shapiro CL(PubMed)
(131) Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada(CMAJ)
(132) Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis by Jehoon Lee, M.D.1 and Samuel Vasikaran, M.D.(PMC)
(133) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis by Glen M Blake and Ignac Fogelman(PMC)
(134) The clinical role of dual energy X-ray absorptiometry by Blake GM1, Fogelman I.(PubMed)
(135) Assessment of osteoporosis by quantitative ultrasound versus dual energy X-ray absorptiometry in children with chronic rheumatic diseases by Hartman C1, Shamir R, Eshach-Adiv O, Iosilevsky G, Brik R.(PubMed)
(136) Review of comparative studies between bone densitometry and quantitative ultrasound of the calcaneus in osteoporosis by Flöter M1, Bittar CK, Zabeu JL, Carneiro AC.(PubMed)
(137) Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group by Glüer CC.(PubMed)
(138) Quantitative computed tomography in assessment of osteoporosis by Genant HK1, Block JE, Steiger P, Glueer CC, Smith R.(PubMed)+
(139) Osteoporosis: assessment by quantitative computed tomography by Genant HK, Ettinger B, Cann CE, Reiser U, Gordan GS, Kolb FO.(PubMed)
(140) Assessment of metabolic bone diseases by quantitative computed tomography by Richardson ML, Genant HK, Cann CE, Ettinger B, Gordan GS, Kolb FO, Reiser UJ.(PubMed)
(141) Better tools for assessing osteoporosis. by Riggs BL1, Khosla S, Melton LJ 3rd(PubMed)
(142) High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis by Graeff C1, Marin F, Petto H, Kayser O, Reisinger A, Peña J, Zysset P, Glüer CC.(PubMed)
(143) [Molecular genetic analysis and clinical aspects of patients with hereditary hemochromatosis].[Article in German] by Lange U1, Teichmann J, Dischereit G.(PubMed)
(144) Association between iron overload and osteoporosis in patients with hereditary hemochromatosis by Valenti L1, Varenna M, Fracanzani AL, Rossi V, Fargion S, Sinigaglia L.(PubMed)
(145) Miscellaneous non-inflammatory musculoskeletal conditions. Haemochromatosis: the bone and the joint of  Guggenbuhl P1, Brissot P, Loréal O(PubMed)
(146) Hereditary hemochromatosis: missed diagnosis or misdiagnosis? by Cherfane CE1, Hollenbeck RD, Go J, Brown KE.(PubMed)
(147) [Hereditary hemochromatosis: presenting manifestations and diagnostic delay].[Article in French] by Gasser B1, Courtois F2, Hojjat-Assari S3, Sauleau EA4, Buffet C5, Brissot P6.(PubMed)
(148) Multiple Myeloma (Myeloma) by Kyle J. Norton
(149) Multiple myeloma and bone disease: pathogenesis and current therapeutic approaches
E C Papadopoulou, S P Batzios, M Dimitriadou, V Perifanis, and V Garipidou(PMC)
(150) Bone antiresorptive agents in the treatment of bone metastases associated with solid tumours or multiple myeloma by Terpos E1, Confavreux CB2, Clézardin P3.(PubMed)
(151) Vertebral augmentation in osteoporosis and bone metastasis by Siemionow K1, Lieberman IH.(PubMed)
(152) Coexistent osteoporosis and multiple myeloma: when to investigate further in osteoporosis.
Mumford ER1, Raffles S1, Reynolds P2.(PubMed)
(153) Bone status and fractures in 85 adults with Wilson's disease by Quemeneur AS1, Trocello JM, Ea HK, Ostertag A, Leyendecker A, Duclos-Vallée JC, de Vernejoul MC, Woimant F, Lioté F.(PubMed)
(154) Bone mineral density of children with Wilson disease: efficacy of penicillamine and zinc therapy by Selimoglu MA1, Ertekin V, Doneray H, Yildirim M.(PubMed)
(155) Fracture in a Young Male Patient Leading to the Diagnosis of Wilson's Disease: A Case Report. by Shin JJ1, Lee JP1, Rah JH1.(PubMed)
(156) Crohn's Disease". National Digestive Diseases Information Clearinghouse (NDDIC). July 10, 2013. Retrieved 12 June 2014.
(157) [Inflammatory bowel disease and bone decreased bone mineral density].[Article in Japanese] by Hisamatsu T1, Wada Y2, Kanai T3.(PubMed)
(158) Risk factors for decreased bone mineral density in inflammatory bowel disease: A cross-sectional study by Wada Y1, Hisamatsu T2, Naganuma M3, Matsuoka K4, Okamoto S4, Inoue N3, Yajima T4, Kouyama K5, Iwao Y6, Ogata H3, Hibi T7, Abe T5, Kanai T4(PubMed)
(159) Bone mineral density in Iranian patients with inflammatory bowel disease by Zali M1, Bahari A, Firouzi F, Daryani NE, Aghazadeh R, Emam MM, Rezaie A, Shalmani HM, Naderi N, Maleki B, Sayyah A, Bashashati M, Jazayeri H, Zand S.(PubMed)
(160) [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Osteoporosis associated with lifestyle-related diseases: other lifestyle-related diseases].[Article in Japanese] by Yamauchi M1.(PubMed)
(161) Premature aging in chronic kidney disease and chronic obstructive pulmonary disease: similarities and differences by Kooman JP1, Shiels PG, Stenvinkel P.(PubMed)
(162) Osteoporosis biomarkers act as predictors for diagnosis of chronic renal insufficiency in elder patients by Li ZX1, Xu C1, Li YC1, Sun QM2.(PubMed)
(163) [Bone and Nutrition. Nutrition care of renal osteodystrophy].[Article in Japanese] by Tanaka S1, Ito M.(PubMed)
(164) Cerebritis, Lupus, and Lupus Cerebritis by Kyle J. Norton
(165) Osteoporosis in patients with systemic lupus erythematosus by García-Carrasco M1, Mendoza-Pinto C, Escárcega RO, Jiménez-Hernández M, Etchegaray Morales I, Munguía Realpozo P, Rebollo-Vázquez J, Soto-Vega E,Delezé M, Cervera R.(PubMed)
(166) Prevalence and predictors of fragility fractures in systemic lupus erythematosus by Yee CS1, Crabtree N, Skan J, Amft N, Bowman S, Situnayake D, Gordon C.(PubMed)
(167) Medicines that May Cause Bone Loss(National Osteoporosis foundation)
(168) Anti-myelin antibodies play an important role in the susceptibility to develop proteolipid protein-induced experimental autoimmune encephalomyelitis by Marín N1, Eixarch H, Mansilla MJ, Rodríguez-Martín E, Mecha M, Guaza C, Álvarez-Cermeño JC, Montalban X, Villar LM, Espejo C.(PubMed)
(169) Osteoporosis in multiple sclerosis by Hearn AP1, Silber E.(PubMed)
(170) Bone health and multiple sclerosis by Dobson R1, Ramagopalan S, Giovannoni G.(PubMed)
(171) Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications?by Kampman MT1, Eriksen EF, Holmøy T.(PubMed)
(172) Biomarkers of bone metabolism in ankylosing spondylitis in relation to osteoproliferation and osteoporosis by Klingberg E1, Nurkkala M2, Carlsten H2, Forsblad-d'Elia H2.(PubMed)
(173) Biomarkers and cytokines of bone turnover: extensive evaluation in a cohort of patients with ankylosing spondylitis by Taylan A1, Sari I, Akinci B, Bilge S, Kozaci D, Akar S, Colak A, Yalcin H, Gunay N, Akkoc N.(PubMed)
(174) Inflammation, bone loss and fracture risk in spondyloarthritis by Briot K1, Roux C1.(PubMed)
(175) [Osteoporosis and bone alterations in celiac disease in adults].[Article in Czech] by Hoffmanová I, Anděl M.(PubMed)
(176) Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment by Krupa-Kozak U1.(PubMed)
(177) Bone mineral density in children with untreated and treated celiac disease by Kavak US1, Yüce A, Koçak N, Demir H, Saltik IN, Gürakan F, Ozen H.(PubMed)
(178) Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes by Mathen PG1, Thabah MM2, Zachariah B3, Das AK4.(PubMed)
(179) Prevalence of osteoporosis among postmenopausal females with diabetes mellitus by Al-Maatouq MA1, El-Desouki MI, Othman SA, Mattar EH, Babay ZA, Addar M.(PubMed)
(180) Increased risk of osteoporosis in postmenopausal women with type 2 diabetes mellitus: a three-year longitudinal study with phalangeal QUS measurements by Neglia C1, Agnello N1, Argentiero A1, Chitano G1, Quarta G1, Bortone I1, Della Rosa G1, Caretto A2, Distante A1, Colao A3, Di Somma C4, Migliore A5,Auriemma RS6, Piscitelli P6.(PubMed)
(181) Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus by Leidig-Bruckner G1, Grobholz S, Bruckner T, Scheidt-Nave C, Nawroth P, Schneider JG.(PubMed)
(182) Primary hyperparathyroidism and osteoporosis by Mazzuoli GF1, D'Erasmo E, Pisani D(PubMed)
(183) Secondary hyperparathyroidism in primary osteoporosis and osteopenia: optimizing calcium and vitamin D intakes to levels recommended by expert panels may not be sufficient for correction by Yendt ER1, Kovacs KA, Jones G.(PubMed)
(184) Effects of oral alendronate in elderly patients with osteoporosis and mild primary hyperparathyroidism by Rossini M1, Gatti D, Isaia G, Sartori L, Braga V, Adami S.(PubMed)
(185) Thyroid hormone excess rather than thyrotropin deficiency induces osteoporosis in hyperthyroidism by Bassett JH1, O'Shea PJ, Sriskantharajah S, Rabier B, Boyde A, Howell PG, Weiss RE, Roux JP, Malaval L, Clement-Lacroix P, Samarut J, Chassande O,Williams GR.(PubMed)
(186) [Osteoporosis treatment in patients with hyperthyroidism].[Article in Japanese] by Saito J1, Nishikawa T.(PubMed)
(187) [Graves' disease and bone metabolism].[Article in Japanese] by Sato K1.(PubMed)
(188) Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this thyroid status a risk factor for osteoporosis? by Földes J1, Tarján G, Szathmari M, Varga F, Krasznai I, Horvath C.(PubMed)
(189) Skeletal diseases in Cushing's syndrome: osteoporosis versus arthropathy by Kaltsas G1, Makras P.(PubMed)
(190) Glucocorticoid-induced osteoporosis: pathophysiology and therapy by Canalis E1, Mazziotti G, Giustina A, Bilezikian JP.(PubMed)
(191) [Glucocorticoid-induced osteoporosis].[Article in Japanese] by Suzuki Y.(PubMed)
(192) [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Drug-induced osteoporosis:glucocorticoid-induced osteoporosis].[Article in Japanese]by Suzuki Y1.(PubMed)
(193) Most common Types of Cancer - Leukemia by Kyle J. Norton
(194) Lymphoma (Non Hodgkin's Lymphoma) by Kyle J. Norton
(195) Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) research program by Halton J1, Gaboury I, Grant R, Alos N, Cummings EA, Matzinger M, Shenouda N, Lentle B, Abish S, Atkinson S, Cairney E, Dix D, Israels S, Stephure D, Wilson B, Hay J, Moher D, Rauch F, Siminoski K, Ward LM; Canadian STOPP Consortium(PubMed)
(196) Bone mineralization defects after treatment of acute lymphoblastic leukemia ın children.Guren by Dolu M1, Canbolat Ayhan A, Erguven M, Timur C, Yoruk A, Ozdemir S.(PubMed)
(197) Treatment of osteoporosis/osteopenia in pediatric leukemia and lymphoma.Bryant ML1, Worthington MA, Parsons K(PubMed)
(198) Lymphoplasmacytoid lymphoma presenting as severe osteoporosis.
Atoyebi W1, Brown M, Wass J, Littlewood TJ, Hatton C.(PubMed)(201) Sickle cell disease with osteogenesis imperfecta by Patil PL, Rao BV.(PubMed)
(199) [Evaluation of bone mineral density in children with sickle cell disease].[Article in Spanish] by Garrido Colino C1, Beléndez Bieler C2, Pérez Díaz M3, Cela de Julián E2.(PubMed)
(200) Predictors of abnormal bone mass density in adult patients with homozygous sickle-cell disease by Garadah TS1, Hassan AB1, Jaradat AA2, Diab DE2, Kalafalla HO2, Kalifa AK3, Sequeira RP2, Alawadi AH1(PubMed)
(201) Sickle cell disease with osteogenesis imperfecta by Patil PL, Rao BV.(PubMed)
(202) Osteoporosis in thalassemia major: an update and the I-CET 2013 recommendations for surveillance and treatment by De Sanctis V1, Soliman AT2, Elsedfy H3, Yassin M4, Canatan D5, Kilinc Y6, Sobti P7, Skordis N8, Karimi M9, Raiola G10, Galati MC11, Bedair E12, Fiscina B13,El Kholy M3; I-CET (International Network on Growth Disorders and Endocrine Complications in Thalassemia)(PubMed)
(203) Pathogenesis and management of osteoporosis in thalassemia by Voskaridou E1, Terpos E.(PubMed)
(204) Use of hormone replacement therapy for correction of high turnover bone disease in hypogonadal β-Thalassemiamajor patients presenting with osteoporosis: comparison with idiopathic premature ovarian failure by Chatterjee R1, Katz M, Bajoria R.(PubMed)
(205) New advances in imaging osteoporosis and its complications by Griffith JF1, Genant HK.(PubMed)
(206) Stress fractures by Dr Yuranga Weerakkody and Dr Frank Gaillard
(207) Severe osteoporosis: diagnosis of non-hip non-vertebral (NHNV) fractures by Giovanni D’Elia,1 Giuliana Roselli,1 Loredana Cavalli,2 Paolo Innocenti,1 and Maria Luisa Brandi2(PubMed)
(208) Whole bone geometry and bone quality in distal forearm fracture by Parkinson IH1, Fazzalari NL.(PubMed)
(209) Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density inosteoporosis by Shiraki M1, Shiraki Y, Aoki C, Miura M.(PubMed)
(210) Short-term menatetrenone therapy increases gamma-carboxylation of osteocalcin with a moderate increase ofbone turnover in postmenopausal osteoporosis: a randomized prospective study by Shiraki M1, Itabashi A.(PubMed)
(211) Association of Body Weight and Body Mass Index with Bone Mineral Density in Women and Men from Kosovo by Rexhepi S1, Bahtiri E2, Rexhepi M1, Sahatciu-Meka V3, Rexhepi B1.(PubMed)
(212) Should we prescribe calcium or vitamin D supplements to treat or prevent osteoporosis? by Bolland MJ1, Grey A1, Reid IR1.(PubMed)
(213) Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis by Health Quality Ontario(PubMed)
(214) Bone Health and Osteoporosis: A Report of the Surgeon General by Rockville (MD): Office of the Surgeon General (US); 2004.
(215) Positive effects of physiotherapy on chronic pain and performance in osteoporosis by Malmros B1, Mortensen L, Jensen MB, Charles P.(PubMed)
(216) [Therapeutic agents for osteoporotic pain].[Article in Japanese] by Nakao S, Miyamoto E, Kawakami M.(PubMed)
(217) A randomized control trial on the effectiveness of osteopathic manipulative treatment in reducing pain and improving the quality of life in elderly patients affected by osteoporosis by Papa L1, Mandara A, Bottali M, Gulisano V, Orfei S.(PubMed)
(218) Trabecular bone score (TBS) predicts vertebral fractures in Japanese women over 10 years independently ofbone density and prevalent vertebral deformity: the Japanese Population-Based Osteoporosis (JPOS) cohort study by Iki M1, Tamaki J, Kadowaki E, Sato Y, Dongmei N, Winzenrieth R, Kagamimori S, Kagawa Y, Yoneshima H.(PubMed)
(219) Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature by Mori K1, Nishizawa K1, Nakamura A1, Imai S1(PubMed)
(220) Osteoporosis prevention, diagnosis, and therapy by NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy(PubMed)
(221) Osteoporosis prevention, diagnosis, and therapy by [No authors listed](PubMed)
(222) Eating Guidelines to Prevent Osteoporosis - It's Never Too Late! by dietitian of Canada
(223) Calcium, dairy products and osteoporosis by Heaney RP1.(PubMed)
(224) Dairy products, dietary calcium and bone health: possibility of prevention of osteoporosis in women: the Polish experience by Wadolowska L1, Sobas K, Szczepanska JW, Slowinska MA, Czlapka-Matyasik M, Niedzwiedzka E.(PubMed)
(225) Dairy intakes affect bone density in the elderly by McCabe LD1, Martin BR, McCabe GP, Johnston CC, Weaver CM, Peacock M.(PubMed)
(226) Prevalence of osteoporosis according to nutrient and food group intake levels in Korean postmenopausalwomen: using the 2010 Korea National Health and Nutrition Examination Survey Data by Lim YS1, Lee SW1, Tserendejid Z1, Jeong SY1, Go G1, Park HR1.(PubMed)
(227) Vitamin D and intestinal calcium absorption by Christakos S1, Dhawan P, Porta A, Mady LJ, Seth T.(PubMed)
(228) Calcium and vitamin D nutrition and bone disease of the elderly by Gennari C1.(PubMed)
(229) Green tea supplementation benefits body composition and improves bone properties in obese female rats fed with high-fat diet and caloric restricted diet by Shen CL1, Han J2, Wang S3, Chung E4, Chyu MC5, Cao JJ6.(PubMed)
(230) Mitigation of oxidative damage by green tea polyphenols and Tai Chi exercise in postmenopausal women with osteopenia by Qian G1, Xue K, Tang L, Wang F, Song X, Chyu MC, Pence BC, Shen CL, Wang JS.(PubMed)
(231) Tea polyphenols inhibit rat osteoclast formation and differentiation by Oka Y1, Iwai S, Amano H, Irie Y, Yatomi K, Ryu K, Yamada S, Inagaki K, Oguchi K.(PubMed)
(232) Green tea polyphenol epigallocatechin 3-gallate in arthritis: progress and promis by Salahuddin Ahmed(PubMed)
(233) Green Tea and Bone metabolismby Chwan-Li Shen,1 James K. Yeh,2 Jay Cao,3 and Jia-Sheng Wang4(PMC)
(233a) Role of phytoestrogenic oils in alleviating osteoporosis associated with ovariectomy in rats by Hassan HA1, El Wakf AM, El Gharib NE.(PubMed)
(234) Osteoprotective effect of soybean and sesame oils in ovariectomized rats via estrogen-like mechanism by El Wakf AM1, Hassan HA, Gharib NS(PubMed)
(235) [Effects on health of soy in menopausic women].[Article in Spanish] by de Luis DA1, Aller R, Sagrado J.(PubMed)
(236) Soy proteins and isoflavones affect bone mineral density in older women: a randomized controlled trial1,2,3 by Anne M Kenny, Kelsey M Mangano, Robin H Abourizk, Richard S Bruno, Denise E Anamani, Alison Kleppinger,Stephen J Walsh, Karen M Prestwood, and Jane E Kerstetter(PMC)
(237) Effect of soy isoflavone extract supplements on bone mineral density in menopausal women: meta-analysis of randomized controlled trials by Taku K1, Melby MK, Takebayashi J, Mizuno S, Ishimi Y, Omori T, Watanabe S.(PubMed)
(238) Evaluation of food products fortified with oyster shell for the prevention and treatment of osteoporosis by Ahmed SA1, Gibriel AA2, Abdellatif AK1, Ebied HM3.(PubMed)
(239) The effect of spiny lobster shell powder on bone metabolism in ovariectomized osteoporotic model rats by Omi N1, Morikawa N, Ezawa I.(PubMed)
(240) Consumption of calcium-fortified cereal bars to improve dietary calcium intake of healthy women: randomized controlled feasibility study by Lee JT1, Moore CE2, Radcliffe JD2.(PubMed)
(241) The selection and prevalence of natural and fortified calcium food sources in the diets of adolescent girls by Rafferty K1, Watson P, Lappe JM.(PubMed)
(242) Calcium absorption from commonly consumed vegetables in healthy Thai women by Charoenkiatkul S1, Kriengsinyos W, Tuntipopipat S, Suthutvoravut U, Weaver CM.(PubMed)
(242) Calcium absorption from kale by Heaney RP1, Weaver CM.(PubMed)
(243) Oxalate: effect on calcium absorbability by Heaney RP1, Weaver CM.(PubMed)
(244) Calcium absorbability from spinach by Heaney RP1, Weaver CM, Recker RR.(PubMed)
(245) Protein Phosphatase 2A Mediates Oxidative Stress Induced Apoptosis in Osteoblasts by Huang CX1, Lv B1, Wang Y1.(PubMed)
(246) Hydrogen sulfide protects MC3T3-E1 osteoblastic cells against H2O2-induced oxidative damage-implications for the treatment of osteoporosis by Xu ZS1, Wang XY, Xiao DM, Hu LF, Lu M, Wu ZY, Bian JS.(PubMed)
(247) Antioxidant status in patients with osteoporosis: a controlled study by Sendur OF1, Turan Y, Tastaban E, Serter M.(PubMed)
(248) Role of antioxidant systems, lipid peroxidation, and nitric oxide in postmenopausal osteoporosis by Ozgocmen S1, Kaya H, Fadillioglu E, Aydogan R, Yilmaz Z.(PubMed)
(249) Marked decrease in plasma antioxidants in aged osteoporotic women: results of a cross-sectional study by Maggio D1, Barabani M, Pierandrei M, Polidori MC, Catani M, Mecocci P, Senin U, Pacifici R, Cherubini A.(PubMed)
(250) Alterations of antioxidant enzymes and oxidative stress markers in aging by Kasapoglu M1, Ozben T.(PubMed)
(251) Protective effect of total and supplemental vitamin C intake on the risk of hip fracture--a 17-year follow-up from the Framingham Osteoporosis Study by Sahni S1, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL.(PubMed)
(252) Exploiting the antioxidant potential of a common vitamin: could vitamin C prevent postmenopausal osteoporosis? by Talaulikar VS1, Chambers T, Manyonda I.(PubMed)
(253) Antioxidant vitamin supplements and markers of bone turnover in a community sample of nonsmoking women by Pasco JA1, Henry MJ, Wilkinson LK, Nicholson GC, Schneider HG, Kotowicz MA.(PubMed)
(254) No increase in risk of hip fracture at high serum retinol concentrations in community-dwelling older Norwegians: the Norwegian Epidemiologic Osteoporosis Studies by Holvik K1, Ahmed LA2, Forsmo S3, Gjesdal CG4, Grimnes G5, Samuelsen SO6, Schei B7, Blomhoff R8, Tell GS9, Meyer HE10.(PubMed)
(255) Serum retinoids and beta-carotene as predictors of hip and other fractures in elderly women by Barker ME1, McCloskey E, Saha S, Gossiel F, Charlesworth D, Powers HJ, Blumsohn A.(PubMed)
(256) Vitamin A intake and osteoporosis: a clinical review by Crandall C1.(PubMed)
(257) Bones and nutrition: common sense supplementation for osteoporosis by Advani S1, Wimalawansa SJ.(PubMed)
(258) Calcium and vitamin D nutrition and bone disease of the elderly by Gennari C1(PubMed)
(259) High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors by Zhen D1, Liu L2, Guan C3, Zhao N4, Tang X5.(PubMed)
(259) Vitamin D deficiency in northern Vietnam: prevalence, risk factors and associations with bone mineral density by Nguyen HT1, von Schoultz B, Nguyen TV, Dzung DN, Duc PT, Thuy VT, Hirschberg AL.(PubMed)
(260) Vitamin D deficiency and aging: implications for general health and osteoporosis by Eriksen EF1, Glerup H(PubMed)
(261) The standardized creation of a lumbar spine vertebral compression fracture in a sheep osteoporosis model induced by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet by Eschler A1, Röpenack P2, Herlyn PK2, Roesner J3, Pille K2, Büsing K4, Vollmar B5, Mittlmeier T2, Gradl G6.(PubMed)
(262) [Guidelines on prevention and treatment of vitamin D deficiency. Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS)].[Article in Italian] by Adami S1, Romagnoli E, Carnevale V, Scillitani A, Giusti A, Rossini M, Gatti D, Nuti R, Minisola S; Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS).(PubMed)
(263) Lower vitamin E serum levels are associated with osteoporosis in early postmenopausal women: a cross-sectional study by Mata-Granados JM1, Cuenca-Acebedo R, Luque de Castro MD, Quesada Gómez JM.(PubMed)
(264) Vitamin D receptor variability and physical activity are jointly associated with low handgrip strength andosteoporosis in community-dwelling elderly people in Taiwan: the Taichung Community Health Study for Elders (TCHS-E) by Wu FY1, Liu CS, Liao LN, Li CI, Lin CH, Yang CW, Meng NH, Lin WY, Chang CK, Hsiao JH, Li TC, Lin CC.(PubMed)
(265) Vitamin D receptor (VDR) gene polymorphism influences the risk of osteoporosis in postmenopausal women of Northwest India by Singh M1, Singh P, Singh S, Juneja PK, Kaur T.(PubMed)
(266) Effect of supplementation of vitamin C and E on oxidative stress in osteoporosis by Chavan SN1, More U, Mulgund S, Saxena V, Sontakke AN.(PubMed)
(267) Vitamin K₂ therapy for postmenopausal osteoporosis by Iwamoto J1.(PubMed)
(268) Inverse correlation between the changes of lumbar bone mineral density and serum undercarboxylated osteocalcin after vitamin K2 (menatetrenone) treatment in children treated with glucocorticoid and alfacalcidol by Inoue T1, Sugiyama T, Matsubara T, Kawai S, Furukawa S.(PubMed)
(269) Short-term effect of vitamin K administration on prednisolone-induced loss of bone mineral density in patients with chronic glomerulonephritis by Yonemura K1, Kimura M, Miyaji T, Hishida A.(PubMed)
(270) Protective effect of vitamins K2 and D3 on prednisolone-induced loss of bone mineral density in the lumbar spine by Yonemura K1, Fukasawa H, Fujigaki Y, Hishida A.(PubMed)
(271) The role of trace minerals in osteoporosis by Saltman PD1, Strause LG.(PubMed)
(272) Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals by Strause L1, Saltman P, Smith KT, Bracker M, Andon MB.(PubMed)
(273) Influence of the forms and levels of dietary selenium on antioxidant status and oxidative stress-related parameters in rainbow trout (Oncorhynchus mykiss) fry by Fontagné-Dicharry S1, Godin S2, Liu H1, Antony Jesu Prabhu P1, Bouyssière B2, Bueno M2, Tacon P3, Médale F1, Kaushik SJ1.(PubMed)
(274) The immune system is limited by oxidative stress: Dietary selenium promotes optimal antioxidative status and greatest immune defense in pacu Piaractus mesopotamicus by Biller-Takahashi JD1, Takahashi LS2, Mingatto FE3, Urbinati EC4.(PubMed)
(275) Selenium combined with vitamin E and vitamin C restores structural alterations of bones in heparin-inducedosteoporosis by Turan B1, Can B, Delilbasi E(PubMed)
(276) Dietary products consumption in relation to serum 25-hydroxyvitamin D and selenium level in Saudi children and adults by Al-Daghri NM1, Al-Attas O1, Yakout S1, Aljohani N2, Al-Fawaz H3, Alokail MS1.(PubMed)
(277) Simultaneous subchronic exposure to selenium and diazinon as possible risk factor for osteoporosis in adult male rats by Martiniaková M, Boboňová I, Omelka R, Grosskopf B1, Chovancová H, Spanková J, Toman R.(PubMed)
(278) Structural changes in femoral bone tissue of rats after subchronic peroral exposure to selenium by Martiniaková M1, Boboňová I, Omelka R, Grosskopf B, Stawarz R, Toman R.(PubMed)
(279) The protective effect of calcium on bone mass in postmenopausal women with high selenium intake by Pedrera-Zamorano JD1, Calderon-García JF, Roncero-Martin R, Mañas-Nuñez P, Moran JM, Lavado-Garcia JM.(PubMed)
(280) In vitro degradability, bioactivity and primary cell responses to bone cements containing mesoporousmagnesium-calcium silicate and calcium sulfate for bone regeneration by Ding Y1, Tang S1, Yu B2, Yan Y3, Li H3, Wei J4, Su J5.(PubMed)
(281) In vitro degradability, bioactivity and primary cell responses to bone cements containing mesoporous magnesium–calcium silicate and calcium sulfate for bone regeneratio by Yueting Ding, Songchao Tang, Baoqing Yu, Yonggang Yan, Hong Li, Jie Wei, Jiacan Su(The Royral Society)
(282) Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study by Orchard TS1, Larson JC, Alghothani N, Bout-Tabaku S, Cauley JA, Chen Z, LaCroix AZ, Wactawski-Wende J, Jackson RD.(PubMed)
(283) Bone. Maximizing bone health--magnesium, BMD and fractures by Nieves JW1.(PubMed)
(284) [Nutrition and bone health. Magnesium and bone].[Article in Japanese] by Ishimi Y1.(PubMed)
(285) The standardized creation of a lumbar spine vertebral compression fracture in a sheep osteoporosis model induced by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet by Eschler A1, Röpenack P2, Herlyn PK2, Roesner J3, Pille K2, Büsing K4, Vollmar B5, Mittlmeier T2, Gradl G6.(PubMed)
(286) Low vitamin D, and bone mineral density with depressive symptoms burden in menopausal and postmenopausalwomen by Bener A1, Saleh NM2.(PubMed)
(287) Calcium and vitamin D nutrition and bone disease of the elderly by Gennari C1.(PubMed)
(288) Prevention of hip fractures by correcting calcium and vitamin D insufficiencies in elderly people. by Meunier P1.(PubMed)
(289) Screening for Vitamin D Deficiency: Systematic Review for the U.S. Preventive Services Task Force Recommendation [Internet] by LeBlanc E, Chou R, Zakher B, Daeges M, Pappas M.(PubMed)
(290) Vitamin D and intestinal calcium absorption by Christakos S1, Dhawan P, Porta A, Mady LJ, Seth T.(PubMed)
(291) Copper, magnesium, zinc and calcium status in osteopenic and osteoporotic post-menopausal women by Mahdavi-Roshan M1, Ebrahimi M2, Ebrahimi A3.(PubMed)
(292) Magnesium, zinc and copper status in osteoporotic, osteopenic and normal post-menopausal women by Mutlu M1, Argun M, Kilic E, Saraymen R, Yazar S.(PubMed)
(293) Low serum levels of zinc, copper, and iron as risk factors for osteoporosis: a meta-analysis by Zheng J1, Mao X, Ling J, He Q, Quan J.(PubMed)
(294) Magnesium, zinc, copper, manganese, and selenium levels in postmenopausal women with osteoporosis. Can magnesium play a key role in osteoporosis? by Odabasi E1, Turan M, Aydin A, Akay C, Kutlu M.(PubMed)
(295) Glyphosate, pathways to modern diseases III: Manganese, neurological diseases, and associated pathologies by Samsel A1, Seneff S2.(PubMed)
(296) Effects of manganese deficiency on the microstructure of proximal tibia and OPG/RANKL gene expression in chicks by Liu R1, Jin C, Wang Z, Wang Z, Wang J, Wang L.(PubMed)
(297) Higher Dietary Acidity is Associated with Lower Bone Mineral Density in Postmenopausal Iranian Women, Independent of Dietary Calcium Intake by Shariati-Bafghi SE1, Nosrat-Mirshekarlou E, Karamati M, Rashidkhani B.(PubMed)
(298) Role of nutritional zinc in the prevention of osteoporosis by Yamaguchi M1.(PubMed)
(299) Nutritional factors and bone homeostasis: synergistic effect with zinc and genistein in osteogenesis by Yamaguchi M1(PubMed)
(300) Implications of compromised zinc status on bone loss associated with chronic inflammation in C57BL/6 mice by Chongwatpol P1, Rendina-Ruedy E1, Stoecker BJ1, Clarke SL1, Lucas EA1, Smith BJ1.(PubMed)
(301) Zinc deficiency exaggerates diabetic osteoporosis by Fushimi H1, Inoue T, Yamada Y, Horie 
(302) Sodium fluoride therapy of postmenopausal osteoporosis. by Kleerekoper M1, Mendlovic DB.(PubMed)
(303) Comparison of nonrandomized trials with slow-release sodium fluoride with a randomized placebo-controlled trial in postmenopausal osteoporosis by Pak CY1, Adams-Huet B, Sakhaee K, Bell NH, Licata A, Johnston C, Rubin B, Bonnick S, Piziak V, Graham H, Ballard J, Berger R, Fears W, Breslau N, Rubin C.(PubMed)
(304) Slow-release sodium fluoride in the management of postmenopausal osteoporosis. A randomized controlled trial by Pak CY1, Sakhaee K, Piziak V, Peterson RD, Breslau NA, Boyd P, Poindexter JR, Herzog J, Heard-Sakhaee A, Haynes S, Adams-Huet B, Reisch JS.(PubMed)
(305) Treatment of postmenopausal osteoporosis with slow-release sodium fluoride. Final report of a randomized controlled trial by Pak CY1, Sakhaee K, Adams-Huet B, Piziak V, Peterson RD, Poindexter JR.(PubMed)
(306) Antioxidants and bone turnover in involutional osteoporosis by Maggio D1, Barabani M, Pierandrei M, Macchiarulo MC, Cecchetti R, Pedrazzoni M, Senin U, Cherubini A.(PubMed)
(307Correlation between bone mineral density and oxidative stress in postmenopausal women by Sharma T1, Islam N2, Ahmad J3, Akhtar N4, Beg M1.(PubMed)
(308) Supplementation with the antioxidant lycopene significantly decreases oxidative stress parameters and the bone resorption marker N-telopeptide of type I collagen in postmenopausal women by Mackinnon ES1, Rao AV, Josse RG, Rao LG.(PubMed)
(309) Lycopene treatment against loss of bone mass, microarchitecture and strength in relation to regulatory mechanisms in a postmenopausal osteoporosis model by Ardawi MM1, Badawoud MH2, Hassan SM2, Rouzi AA3, Ardawi JM4, AlNosani NM5, Qari MH6, Mousa SA7.(PubMed)
(310) [Effects of lycopene on the skeletal system].[Article in Polish] by Sołtysiak P1, Folwarczna J1.(PubMed)
(311) Lycopene intake facilitates the increase of bone mineral density in growing female rats by Iimura Y1, Agata U, Takeda S, Kobayashi Y, Yoshida S, Ezawa I, Omi N.(PubMed)
(312) The impact of omega-3 fatty acids on osteoporosis by Maggio M1, Artoni A, Lauretani F, Borghi L, Nouvenne A, Valenti G, Ceda GP.(PubMed)
(313) Dietary n-3 fatty acids decrease osteoclastogenesis and loss of bone mass in ovariectomized mice by Sun D1, Krishnan A, Zaman K, Lawrence R, Bhattacharya A, Fernandes G.(PubMed)
(314) Pros and cons of fatty acids in bone biology by Wauquier F1, Léotoing L1, Philippe C1, Spilmont M1, Coxam V1, Wittrant Y2.(PubMed)
(315) Resveratrol improves oxidative stress and prevents the progression of periodontitis via the activation of the Sirt1/AMPK and the Nrf2/antioxidant defense pathways in a rat periodontitis model by Tamaki N1, Cristina Orihuela-Campos R2, Inagaki Y3, Fukui M2, Nagata T3, Ito HO2.(PubMed)
(316) Resveratrol prevents alveolar bone loss in an experimental rat model of periodontitis.
Bhattarai G1, Poudel SB1, Kook SH2, Lee JC3.(PubMed)
(317) Synthesis, estrogenic activity, and anti-osteoporosis effects in ovariectomized rats of resveratrol oligomer derivatives by Hao XD1, Chang J1, Qin BY2, Zhong C1, Chu ZB1, Huang J3, Zhou WJ4, Sun X5.(PubMed)
(318) Effects of dietary resveratrol on excess-iron-induced bone loss via antioxidative character by Zhao L1, Wang Y2, Wang Z1, Xu Z3, Zhang Q4, Yin M5.(PubMed)
(319) Osteoblastogenesis and osteoprotection enhanced by flavonolignan silibinin in osteoblasts and osteoclasts by Kim JL1, Kang SW, Kang MK, Gong JH, Lee ES, Han SJ, Kang YH(PubMed)
(320) Osteogenic activity of silymarin through enhancement of alkaline phosphatase and osteocalcin in osteoblasts and tibia-fractured mice by Kim JL1, Park SH, Jeong D, Nam JS, Kang YH.(PubMed)
(321) Silibinin promotes osteoblast differentiation of human bone marrow stromal cells via bone morphogenetic protein signaling by Ying X1, Sun L, Chen X, Xu H, Guo X, Chen H, Hong J, Cheng S, Peng L.(PubMed)
(322) Ameliorative effects of Schizandra chinensis on osteoporosis via activation of estrogen receptor (ER)-α/-β by Kim MH1, Choi YY, Han JM, Lee HS, Hong SB, Lee SG, Yang WM.(PubMed)
(323) Antiosteoporotic activity of Saururus chinensis extract in ovariectomized ratsby Sung MJ1, Davaatseren M, Hur HJ, Kim HJ, Ryu SY, Choi YH, Cha MR, Kwon DY.(PubMed)
(324) New lignans from the bioactive fraction of Sambucus williamsii Hance and proliferation activities on osteoblastic-like UMR106 cells byXiao HH1, Dai Y2, Wong MS3, Yao XS4.(PubMed)
(325) Lignans from the stems of Sambucus williamsii and their effects on osteoblastic UMR106 cells.by Yang XJ1, Wong MS, Wang NL, Chan SC, Yao XS.(PubMed)
(326) Correlation between bone mineral density and oxidative stress in postmenopausal women by Sharma T1, Islam N2, Ahmad J3, Akhtar N4, Beg M1.(PubMed)
(327) Decreased osteogenesis of adult mesenchymal stem cells by reactive oxygen species under cyclic stretch: a possible mechanism of age related osteoporosis by Tan J1, Xu X2, Tong Z1, Lin J1, Yu Q3, Lin Y1, Kuang W4.(PubMed)
(328) Mitochondrial superoxide in osteocytes perturbs canalicular networks in the setting of age-related osteoporosis by Kobayashi K1, Nojiri H2, Saita Y2, Morikawa D1, Ozawa Y3, Watanabe K3, Koike M1, Asou Y4, Shirasawa T5, Yokote K6, Kaneko K2, Shimizu T3.(PubMed)
(329) Manganese superoxide dismutase is required to maintain osteoclast differentiation and function under static force by Guo T1, Zhang L2, Konermann A3, Zhou H4, Jin F1, Liu W2.(PubMed)
(330) Time and dose-dependent effects of Labisia pumila on bone oxidative status of postmenopausal osteoporosis rat model by Effendy NM1, Shuid AN2.(PubMed)
(331) Correlation between bone mineral density and oxidative stress in postmenopausal women by Sharma T1, Islam N2, Ahmad J3, Akhtar N4, Beg M1.(PubMed)
(332) CAT catalase [ Homo sapiens (human) ]Gene ID: 847, updated on 8-Nov-2015(NCBI)
(333) The role of phytochemicals as micronutrients in health and disease by Howes MJ1, Simmonds MS.(PubMed)
(334) Fruits and dietary phytochemicals in bone protection by Shen CL1, von Bergen V, Chyu MC, Jenkins MR, Mo H, Chen CH, Kwun IS.(PubMed)
(335) The role of phytochemicals as micronutrients in health and disease by Howes MJ1, Simmonds MS.(PubMed)
(336) In vitro anti-osteoporosis properties of diverse Korean Drynariae rhizoma phenolic extracts. by Kang SN1, Lee JS2, Park JH3, Cho JH4, Park JH5, Cho KK6, Lee OH7, Kim IS8.(PubMed)
(337) Inhibitory activity of Drynariae rhizoma extracts on cathepsin having bone resorption activity.by Jeong JC1, Yoon CH, Jeong CW, Lee YC, Chang YC, Kim CH.(PubMed)
(338) The effects of flavonoids on bone by Welch AA1, Hardcastle AC.(PubMed)
(339) In vitro anti-osteoporosis properties of diverse Korean Drynariae rhizoma phenolic extracts by Kang SN1, Lee JS2, Park JH3, Cho JH4, Park JH5, Cho KK6, Lee OH7, Kim IS8.(PubMed)
(340) The phenolics from the roots of Livistona chinensis show antioxidative and obsteoblast differentiation promoting activity by Zeng X1, Tian J2, Cui L3, Wang Y4, Su Y5, Zhou X6, He X7.(PubMed)
(341) Bioavailability of phenolics from an oleuropein-rich olive (Olea europaea) leaf extract and its acute effect on plasma antioxidant status: comparison between pre- and postmenopausal women by García-Villalba R1, Larrosa M, Possemiers S, Tomás-Barberán FA, Espín JC.(PubMed)
(342) Curcumin, an atoxic antioxidant and natural NFkappaB, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: a shield against acute and chronic diseases by Bengmark S1.(PubMed)
(343) Curcumin alleviates glucocorticoid-induced osteoporosis by protecting osteoblasts from apoptosis in vivo and in vitro by Chen Z1, Xue J2, Shen T1, Ba G1, Yu D1, Fu Q1.(PubMed)
(344) Role of Curcumin in Common Musculoskeletal Disorders: a Review of Current Laboratory, Translational, and Clinical Data by Peddada KV1, Peddada KV2, Shukla SK3, Mishra A3, Verma V4.(PubMed)
(345)Inhibition of osteoclast differentiation by gold nanoparticles functionalized with cyclodextrin curcumincomplexes by Heo DN1, Ko WK, Moon HJ, Kim HJ, Lee SJ, Lee JB, Bae MS, Yi JK, Hwang YS, Bang JB, Kim EC, Do SH, Kwon IK.(PubMed)
(346) Phloridzin reduces blood glucose levels and improves lipids metabolism in streptozotocin-induced diabetic rats by Najafian M1, Jahromi MZ, Nowroznejhad MJ, Khajeaian P, Kargar MM, Sadeghi M, Arasteh A.(PubMed)
(347) Prevention of bone loss by phloridzin, an apple polyphenol, in ovariectomized rats under inflammation conditions by Puel C1, Quintin A, Mathey J, Obled C, Davicco MJ, Lebecque P, Kati-Coulibaly S, Horcajada MN, Coxam V.(PubMed)
(348) Osteoblastic response to pectin nanocoating on titanium surfaces by Gurzawska K1, Svava R2, Yihua Y3, Haugshøj KB3, Dirscherl K4, Levery SB5, Byg I6, Damager I7, Nielsen MW8, Jørgensen B6, Jørgensen NR9, Gotfredsen K10.(PubMed)
(349) Fruits and dietary phytochemicals in bone protection by Shen CL1, von Bergen V, Chyu MC, Jenkins MR, Mo H, Chen CH, Kwun IS.(PubMed)
(350) Drug treatment(Osteoporosis Canada)
(351) A comparative study between intravenous and oral alendronate administration for the treatment of osteoporosis by Horikawa A1, Miyakoshi N2, Shimada Y2, Sugimura Y1, Kodama H1.(PubMed)
(352) Bisphosphonates for treatment of osteoporosis: expected benefits, potential harms, and drug holidays by Brown JP1, Morin S, Leslie W, Papaioannou A, Cheung AM, Davison KS, Goltzman D, Hanley DA, Hodsman A, Josse R, Jovaisas A, Juby A, Kaiser S, Karaplis A, Kendler D, Khan A, Ngui D, Olszynski W, Ste-Marie LG, Adachi J.(PubMed)
(353) Long-term use of bisphosphonates in osteoporosis by Watts NB1, Diab DL(PubMed)
(354) Safety of bisphosphonates by Orozco C1, Maalouf NM.(PubMed)
(355) Ocular side effects associated with bisphosphonates by Fraunfelder FW1.(PubMed)
(356) Do bisphosphonates reduce the risk of osteoporotic fractures? An evaluation of the evidence to date by Hodsman AB1, Hanley DA, Josse R.(PMC)
(357) Bisphosphonates for treatment of osteoporosis: expected benefits, potential harms, and drug holidays.
Brown JP1, Morin S, Leslie W, Papaioannou A, Cheung AM, Davison KS, Goltzman D, Hanley DA, Hodsman A, Josse R, Jovaisas A, Juby A, Kaiser S, Karaplis A, Kendler D, Khan A, Ngui D, Olszynski W, Ste-Marie LG, Adachi J.(PubMed)
(358) Negative spinal bone mineral density changes and subclinical ovulatory disturbances--prospective data in healthy premenopausal women with regular menstrual cycles.
Li D1, Hitchcock CL, Barr SI, Yu T, Prior JC.(PubMed)
(359) Timing of follow-up densitometry in hormone replacement therapy users for optimal osteoporosis prevention by Checa MA1, Del Rio L, Rosales J, Nogués X, Vila J, Carreras R.(PubMed)
(360) Oral versus transdermal hormone replacement therapy by Stevenson JC1, Crook D, Godsland IF, Lees B, Whitehead MI.(PubMed)
(361) Ten reasons to be happy about hormone replacement therapy: a guide for patients by Studd J1.(PubMed)
(362) Hormone therapy and risk of venous thromboembolism among postmenopausal women by Canonico M1, Scarabin PY.(PubMed)
(363) Does hormone replacement therapy and use of oral contraceptives increase the risk of non-melanoma skin cancer? by Birch-Johansen F1, Jensen A, Olesen AB, Christensen J, Tjønneland A, Kjær SK.(PubMed)
(364) Hormone therapy administration in postmenopausal women and risk of stroke by Renoux C1, Suissa S.(PubMed)
(365) Complementary medicine on side-effects of adjuvant hormone therapy in patients with breast cancer by Beuth J1, van Leendert R, Schneider B, Uhlenbruck G.(PubMed)
(366) Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis by Gallagher JC, Riggs BL, DeLuca HF.(PubMed)
(367) Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment by Rapkin AJ1.(PubMed)
(368) Low-dose estrogen therapy for prevention of osteoporosis: working our way back to monotherapy by Richman S1, Edusa V, Fadiel A, Naftolin F.(PubMed)
(370) Adverse effects of estrogen therapy in a subset of women with ITP by Onel K, Bussel JB.(PubMed)
(371) Adverse effects during endocrine therapy for prostatic carcinoma with a high dose of estrogen by Shinkawa T, Ohfuji T, Osada Y, Ishisawa N.(PubMed)
(372) Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease,cancer, and other health outcomes by Bassuk SS1, Manson JE2.(PubMed)
(373) Bone metabolism regulators and arterial stiffness in postmenopausal women by Albu A1, Fodor D, Bondor C, Crăciun AM.(PubMed)
(374) Serum osteoprotegerin and osteopontin levels are associated with arterial stiffness and the presence and severity of coronary artery disease by Tousoulis D1, Siasos G, Maniatis K, Oikonomou E, Kioufis S, Zaromitidou M, Paraskevopoulos T, Michalea S, Kollia C, Miliou A, Kokkou E, Papavassiliou AG,Stefanadis C.(PubMed)
(375) osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification by Bucay N1, Sarosi I, Dunstan CR, Morony S, Tarpley J, Capparelli C, Scully S, Tan HL, Xu W, Lacey DL, Boyle WJ, Simonet WS.(PubMed)
(376) Osteoprotegerin reverses osteoporosis by inhibiting endosteal osteoclasts and prevents vascular calcification by blocking a process resembling osteoclastogenesis by Min H1, Morony S, Sarosi I, Dunstan CR, Capparelli C, Scully S, Van G, Kaufman S, Kostenuik PJ, Lacey DL, Boyle WJ, Simonet WS.(PubMed)
(377) Osteoprotegerin: a physiological and pharmacological inhibitor of bone resorption by Kostenuik PJ1, Shalhoub V.(PubMed)
(378) Effects of abaloparatide, a human parathyroid hormone-related peptide analog, on bone mineral density inpostmenopausal women with osteoporosis by Leder BZ1, O'Dea LS, Zanchetta JR, Kumar P, Banks K, McKay K, Lyttle CR, Hattersley G.(PubMed)
(379) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis by Neer RM1, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH(PubMed)
(380) Single and combined use of human parathyroid hormone (PTH) (1-34) on areal bone mineral density (aBMD) inpostmenopausal women with osteoporosis: evidence based on 9  RCTs by Song J1, Jin Z1, Chang F1, Li L1, Su Y1.(PubMed)
(381) Effects of Denosumab and Calcitriol on Severe Secondary Hyperparathyroidism in Dialysis Patients With Low Bone Mass by Chen CL1, Chen NC1, Liang HL1, Hsu CY1, Chou KJ1, Fang HC1, Lee PT1.(PubMed)
(382) MiR-125b inhibits stromal cell proliferation in giant cell tumor of bone by targeting parathyroid hormone 1 receptor by Wu PF1, Liang JY1, Yu F1, Zhou ZB1, Tang JY1, Li KH1(PubMed)
(383) Lifestyle modifications to improve musculoskeletal and bone health and reduce disability--a life-course approach by Jones G1, Winzenberg TM2, Callisaya ML3, Laslett LL4.(PubMed)
(384) Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study by Nguyen TV1, Sambrook PN, Eisman JA.(PubMed)
(385) Postmenopausal weight change and incidence of fracture: post hoc findings from Women's Health Initiative Observational Study and Clinical Trials by Crandall CJ1, Yildiz VO2, Wactawski-Wende J3, Johnson KC4, Chen Z5, Going SB6, Wright NC7, Cauley JA8.(PubMed)
(386) Independent predictors of all osteoporosis-related fractures among healthy Saudi postmenopausal women: the CEOR Study by Rouzi AA1, Al-Sibiani SA, Al-Senani NS, Radaddi RM, Ardawi MS.(PubMed)
(387) Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function ofpostmenopausal women by Moreira LD1, Oliveira ML1, Lirani-Galvão AP1, Marin-Mio RV1, Santos RN1, Lazaretti-Castro M1.(PubMed)
(388) Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control inpostmenopausal women: a randomized controlled pilot study by Verschueren SM1, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S.(PubMed)
(389) Physical activity in the prevention and amelioration of osteoporosis in women : interaction of mechanical, hormonal and dietary factors by Borer KT1.(PubMed)
(390) Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bonemineral density induced by weight loss despite decline in bone-active hormones by Shah K1, Armamento-Villareal R, Parimi N, Chode S, Sinacore DR, Hilton TN, Napoli N, Qualls C, Villareal DT.(PubMed)
(391) Osteoporosis and inflammation by Mundy GR1.(PubMed)
(392) An association between abnormal bone turnover, systemic inflammation, and osteoporosis in patients with chronic pancreatitis: a case-matched study by Duggan SN1, Purcell C1, Kilbane M2, O'Keane M2, McKenna M2, Gaffney P3, Ridgway PF1, Boran G3, Conlon KC4.(PubMed)
(393) [Regulation of bone metabolism in osteoporosis : Novel drugs for osteoporosis in development].[Article in German]by Jakob F1, Genest F2, Baron G2, Stumpf U3, Rudert M2, Seefried L2.(PubMed)
(394) The effect of garlic tablet on pro-inflammatory cytokines in postmenopausal osteoporotic women: a randomized controlled clinical trial by Mozaffari-Khosravi H1, Hesabgar HA, Owlia MB, Hadinedoushan H, Barzegar K, Fllahzadeh MH.(PubMed)
(395) Role of peritoneal macrophages and lymphocytes in the development of hypogonadal osteoporosis in an ovariectomized rat model: possible phytoestrogenic efficacy of oil extract of garlic to preserve skeletal health by Mukherjee M1, Das AS, Das D, Mukherjee S, Mitra S, Mitra C.(PubMed)
(396) Role of oil extract of garlic (Allium sativum Linn.) on intestinal transference of calcium and its possible correlation with preservation of skeletal health in an ovariectomized rat model of osteoporosis by Mukherjee M1, Das AS, Das D, Mukherjee S, Mitra S, Mitra C.(PubMed)
(397) Effects of garlic oil on postmenopausal osteoporosis using ovariectomized rats: comparison with the effects of lovastatin and 17beta-estradiol by Mukherjee M1, Das AS, Das D, Mukherjee S, Mitra S, Mitra C.(PubMed)
(398) Prevention of bone loss by oil extract of garlic (Allium sativum Linn.) in an ovariectomized rat model ofosteoporosis by Mukherjee M1, Das AS, Mitra S, Mitra C.(PubMed)
(399) Safety and anti-inflammatory activity of curcumin: a component of tumeric (Curcuma longa) by Chainani-Wu N1.(PubMed)
(400) Antioxidant and anti-inflammatory properties of curcumin by Menon VP1, Sudheer AR.(PubMed)
(401) A diarylheptanoid phytoestrogen from Curcuma comosa, 1,7-diphenyl-4,6-heptadien-3-ol, accelerates human osteoblast proliferation and differentiation by Tantikanlayaporn D1, Robinson LJ, Suksamrarn A, Piyachaturawat P, Blair HC.(PubMed)
(402) Bone sparing effect of a novel phytoestrogen diarylheptanoid from Curcuma comosa Roxb. in ovariectomized rats by Tantikanlayaporn D1, Wichit P, Weerachayaphorn J, Chairoungdua A, Chuncharunee A, Suksamrarn A, Piyachaturawat P.(PubMed)
(403) Curcumin: getting back to the roots by Shishodia S1, Sethi G, Aggarwal BB.(PubMed)
(404) The acute effects of green tea and carbohydrate coingestion on systemic inflammation and oxidative stress during sprint cycling by Suzuki K1, Takahashi M1, Li CY2, Lin SP3, Tomari M1, Shing CM4, Fang SH5.(PubMed)
(405) Green tea polyphenols change the profile of inflammatory cytokine release from lymphocytes of obese and lean rats and protect against oxidative damage by Molina N1, Bolin AP1, Otton R2.(PubMed)
(406) Green tea supplementation benefits body composition and improves bone properties in obese female rats fed with high-fat diet and caloric restricted diet by Shen CL1, Han J2, Wang S3, Chung E4, Chyu MC5, Cao JJ6(PubMed)
(407) Epigallocatechin-3-gallate (EGCG) as a pro-osteogenic agent to enhance osteogenic differentiation of mesenchymal stem cells from human bone marrow: an in vitro study by Jin P1, Wu H, Xu G, Zheng L, Zhao J.(PubMed)
(408) Dietary patterns and osteoporosis risk in postmenopausal korean women by Park SJ1, Joo SE, Min H, Park JK, Kim Y, Kim SS, Ahn Y.(PubMed)
(409) A natural formulation (imoviral™) increases macrophage resistance to LPS-induced oxidative and inflammatorystress in vitro by Menghini L1, Leporini L1, Pintore G2, Ferrante C1, Recinella L1, Orlando G1, Vacca M1, Brunetti L1.(PubMed)
(410) Dietary calcium and vitamin D2 supplementation with enhanced Lentinula edodes improves osteoporosis-like symptoms and induces duodenal and renal active calcium transport gene expression in mice by Lee GS1, Byun HS, Yoon KH, Lee JS, Choi KC, Jeung EB.(PubMed)
(411) The association between onion consumption and bone density in perimenopausal and postmenopausal non-Hispanic white women 50 years and older by Matheson EM1, Mainous AG 3rd, Carnemolla MA.(PubMed)
(412) [Osteoporosis diet].[Article in German] by Morselli B1, Neuenschwander B, Perrelet R, Lippuner K.(PubMed)
(413) Water solution of onion crude powder inhibits RANKL-induced osteoclastogenesis through ERK, p38 and NF-kappaB pathways by Tang CH1, Huang TH, Chang CS, Fu WM, Yang RS.(PubMed)
(360)
(416) Salmon calcitonin (Miacalcic) nasal spray in prevention and treatment of osteoporosis by Gennari C1.(PubMed)
(417) A randomized trial of nasal spray salmon calcitonin in men with idiopathic osteoporosis: effects on bone mineral density and bone markers by Trovas GP1, Lyritis GP, Galanos A, Raptou P, Constantelou E.(PubMed)
(418) Effects of salmon calcitonin treatment on serum and synovial fluid bone formation and resorption markers inosteoporosis patients by Atbinici H1, Sipahioğlu S2, Aksoy N3, Baykara İ2, Işıkan UE2.(PubMed)
(419) Salmon calcitonin in the treatment of elderly women with type 2 diabetes complicated with osteoporosis by Dexue L1, Yueyue Z2.(PubMed)
(420) Efficacy and safety of oral recombinant calcitonin tablets in postmenopausal women with low bone mass and increased fracture risk: a randomized, placebo-controlled trial by Binkley N1, Bone H, Gilligan JP, Krause DS.(PubMed)
(421) A systematic review of omega-3 fatty acids and osteoporosis by Tonya S. Orchard,1 Xueliang Pan,2 Fern Cheek,3 Steven W. Ing,4 and Rebecca D. Jackson4(PMC)
(422) SCD1 mediates the influence of exogenous saturated and monounsaturated fatty acids in adipocytes: Effects on cellular stress, inflammatory markers and fatty acid elongation by Ralston JC1, Metherel AH2, Stark KD3, Mutch DM4.(PubMed)
(423) Levels of bioactive lipids in cooking oils: olive oil is the richest source of oleoyl serine by Bradshaw HB, Leishman E.(PubMed)
(424) Stereological study of the effect of black olive hydroalcoholic extract on osteoporosis in vertebra and tibia in ovariectomized rats by Noorafshan A1, Dabbaghmanesh MH, Tanideh N, Koohpeyma F, Rasooli R, Hajihoseini M, Bakhshayeshkaram M, Hosseinabadi OK.(PubMed)
(425) Olive oil effectively mitigates ovariectomy-induced osteoporosis in rats by Saleh NK1, Saleh HA.(PubMed)
(426) Olive oil in the prevention and treatment of osteoporosis after artificial menopause by Liu H1, Huang H1, Li B1, Wu D1, Wang F1, Zheng Xh1, Chen Q1, Wu B1, Fan X1.(PubMed)
(427) Chronic alcoholism. Frequently overlooked cause of osteoporosis in men by Spencer H, Rubio N, Rubio E, Indreika M, Seitam A.(PubMed)
(428) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs by Scarborough P1, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, Rayner M.(PubMed)
(429) Epidemiological association between osteoporosis and combined smoking and use of snuff among South African women by Ayo-Yusuf OA1, Olutola BG.(PubMed)
(430) Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey by Kim KH1, Lee CM, Park SM, Cho B, Chang Y, Park SG, Lee K.(PubMed)
(431) Dose-related effect of urinary cotinine levels on bone mineral density among Korean females by Myong JP1, Kim HR, Choi SE, Koo JW.(PubMed)
(432) Prevalence and risk factors associated with osteoporosis in women attending menopause clinic at Hat Yai Regional Hospital by Jarupanich T1.(PubMed)
(433) Alcoholic and isocaloric diet, but not ovariectomy, influence the apoptosis of bone cells within the alveolar bone crest of rats by Marchini AM1, Gonçalves LL2, Salgado MC1, do Prado RF1, Marchini L3, Carvalho YR1, da Rocha RF1.(PubMed)
(434) Oral administration of phytocomponent p-hydroxycinnamic acid prevents bone loss in ovariectomized rats by Yamaguchi M1, Lai YL, Uchiyama S, Nakagawa T.(PubMed)
(435) Nutraceutical and antioxidant effects of a delphinidin-rich maqui berry extract Delphinol®: a review by Watson RR1, Schönlau F.(PubMed)
(436) The effect of dried plum on serum levels of receptor activator of NF-κB ligand, osteoprotegerin and sclerostin in osteopenic postmenopausal women: a randomised controlled trial by Hooshmand S1, Brisco JR1, Arjmandi BH2.(PubMed)
(437) Comparative effects of dried plum and dried apple on bone in postmenopausal women by Hooshmand S1, Chai SC, Saadat RL, Payton ME, Brummel-Smith K, Arjmandi BH.(PubMed)
(438) The effect of dried plum on serum levels of receptor activator of NF-κB ligand, osteoprotegerin and sclerostin in osteopenic postmenopausal women: a randomised controlled trial by Hooshmand S1, Brisco JR1, Arjmandi BH2.(PubMed)
(439) Daily apple versus dried plum: impact on cardiovascular disease risk factors in postmenopausal women by Chai SC1, Hooshmand S, Saadat RL, Payton ME, Brummel-Smith K, Arjmandi BH.(PubMed)
(440) Phloretin promotes osteoclast apoptosis in murine macrophages and inhibits estrogen deficiency-inducedosteoporosis in mice by Lee EJ1, Kim JL1, Kim YH1, Kang MK1, Gong JH1, Kang YH2.(PubMed)
(441) Prevention of bone loss by phloridzin, an apple polyphenol, in ovariectomized rats under inflammation conditions by Puel C1, Quintin A, Mathey J, Obled C, Davicco MJ, Lebecque P, Kati-Coulibaly S, Horcajada MN, Coxam V.(PubMed)
(442) Lycopene/tomato consumption and the risk of prostate cancer: a systematic review and meta-analysis of prospective studies by Chen J1, Song Y, Zhang L.(PubMed)
(443) Role of antioxidant lycopene in cancer and heart disease by Rao AV1, Agarwal S.(PubMed)
(444) [Effects of lycopene on the skeletal system].[Article in Polish by Sołtysiak P1, Folwarczna J1.(PubMed)
(445) Lycopene I--effect on osteoclasts: lycopene inhibits basal and parathyroid hormone-stimulated osteoclast formation and mineral resorption mediated by reactive oxygen species in rat bone marrow cultures by Rao LG1, Krishnadev N, Banasikowska K, Rao AV.(PubMed)
(446) Lycopene intake facilitates the increase of bone mineral density in growing female rats by Iimura Y1, Agata U, Takeda S, Kobayashi Y, Yoshida S, Ezawa I, Omi N.(PubMed)
(446a) The Chinese Medicine Diet, Article by Margaret. May 1, 2010
(447) Phytoestrogens in Functional Foods edited by Fatih Yildiz, 2005, 336 pages, CRC Press, Boca Raton, FL by Alison M Duncan( American Society for Clinical Nutrition)
(448) Phytoestrogens for menopausal vasomotor symptoms by Lethaby A1, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J.(PubMed)
(449) [PHYTOESTROGENS AND VITAMIN D FOR BONE HEALTH IN MENOPAUSAL TRANSITION].[Article in Bulgarian] by Malinova M.(PubMed)
(450) Phytoestrogen genistein stimulates the production of osteoprotegerin by human trabecular osteoblasts by Viereck V1, Gründker C, Blaschke S, Siggelkow H, Emons G, Hofbauer LC.(PubMed)
(451) Association between dietary phytoestrogen intake and bone mineral density varied with estrogen receptor alpha gene polymorphisms in southern Chinese postmenopausal women by Luo D1, Liu Y, Zhou Y, Chen Z, Yang L, Liu Y, Xu Q, Xu H, Kuang H, Huang Q, He M, Peng W.(PubMed)
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(454)[Bone and Nutrition. Functional foods for bone and cartilage tissues : Evidence for the action of collagen peptides].[Article in Japanese]by Kimira Y1, Mano H.(PubMed)
(455) N-acylated glucosamines for bone and joint disorders: effects of N-butyryl glucosamine on ovariectomized rat bone by Anastassiades T1, Rees-Milton K, Xiao H, Yang X, Willett T, Grynpas M.(PubMed)
(456) Efficacy of glucosamine alendronate alone & in combination with dihydroquercetin for treatment of osteoporosisin animal model by Muraleva NA1, Ofitserov EN, Tikhonov VP, Kolosova NG.(PubMed)
(457)
(458) Medical Gains of Chondroitin Sulfate upon Fucosylation by Pomin VH1.(PubMed)
(459) Chondroitin sulfate promotes activation of cathepsin K by Lemaire PA1, Huang L2, Zhuo Y2, Lu J3, Bahnck C1, Stachel SJ4, Carroll SS1, Duong LT5.(PubMed)(460) Collagenase activity of cathepsin K depends on complex formation with chondroitin sulfate by Li Z1, Hou WS, Escalante-Torres CR, Gelb BD, Bromme D.(PubMed)
(461) [Reducing bone resorption by cathepsin K inhibitor and treatment of osteoporosis].[Article in Japanese]by Watanabe R1, Okazaki R.(PubMed)

(463) Changes in bone histology due to capacitive electric field stimulation of ovariectomized rat by Behari J1, Behari J.(PubMed)
(464) Changes in bone histology due to capacitive electric field stimulation of ovariectomized rat by Behari J1, Behari J.(PubMed)
(465) Electrical field stimulation improves bone mineral density in ovariectomized rats by Lirani-Galvão AP1, Bergamaschi CT, Silva OL, Lazaretti-Castro M.(PubMed)
(466) the Osteoporosis: Coping With Chronic Pain by National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center
(467) Pathogenesis and clinical aspects of pain in patients with osteoporosis by Mediati RD1, Vellucci R1, Dodaro L1.(PubMed)
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(471) Acupuncture increases bone strength by improving mass and structure in established osteoporosis after ovariectomy in rats by Zhang W1, Kanehara M, Zhang Y, Yu Z, Zhang G, Yang Y, Tachi S, Ishida T.(PubMed)
(472) [Effects of acupuncture on bone metabolism and serum estradiol level in ovariectomy-induced osteoporosisrats].[Article in Chinese] by Ma J1, Yun-guang H, Zhang DH.(PubMed)
(473) [Effect of electroacupuncture on the biochemical indices of bone and bone collagen metabolism and TNF-alpha in osteoporosis model rats without ovaries].[Article in Chinese] by Bao SY1, Zhang SJ, Lin WJ, Chen JF.(PubMed)
(474) Massage Therapy for Osteoporosis(ME)
(475) [Effects of comprehensive therapy on serum SPARC levels in ankylosing spondylitis patients accompanied withosteoporosis].[Article in Chinese] by Xu JR1, Lin Y, Zhang CY, Li WM, Guo CJ, Ye L.(PubMed)
(476) Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review by Guo Z1, Chen W, Su Y, Yuan J, Zhang Y.(PubMed)
(477) [Physiotherapy strategies in osteoporosis--recommendations for daily practice].[Article in German] by Uhlemann C1, Lange U.(PubMed)
(479) Bone mineral density in women on long-term mud-bath therapy in a Salus per Aquam (SPA) environment by Loi A1, Lisci S, Denotti A, Cauli A.(PubMed)
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(485) The effect of a water exercise program on bone density of postmenopausal women by Rotstein A1, Harush M, Vaisman N.(PubMed)
(486) A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis by Arnold CM1, Busch AJ, Schachter CL, Harrison EL, Olszynski WP.(PubMed)
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(489) Tai chi for osteoporosis: a systematic review by Lee MS1, Pittler MH, Shin BC, Ernst E.(PubMed)
(490) [Age and osteoporosis. Effects of aging on osteoporosis, the diagnostics and therapy].[Article in German] by Jakob F1, Seefried L, Schwab M(PubMed)
(491) [Fall risk and fracture. Aging and fall/fracture].[Article in Japanese] by Kozaki K1.(PubMed)
(492) Mitigation of oxidative damage by green tea polyphenols and Tai Chi exercise in postmenopausal women with osteopenia by Qian G1, Xue K, Tang L, Wang F, Song X, Chyu MC, Pence BC, Shen CL, Wang JS.(PubMed)
(493)
(494) Yoga, vertebral fractures, and osteoporosis: research and recommendations by Smith EN, Boser A.(PubMed)
(495) Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series by Sinaki M1(PubMed)
(496) Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis by Tüzün S1, Aktas I, Akarirmak U, Sipahi S, Tüzün F.(PubMed)
(497) Chiropractic spinal manipulative therapy for a geriatric patient with low back pain and comorbidities of cancer, compression fractures, and osteoporosis by Roberts JA1, Wolfe TM.(PubMed)
(498) Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years by Whedon JM1, Mackenzie TA, Phillips RB, Lurie JD.(PubMed)
(499) Chiropractic management of a veteran with lower back pain associated with diffuse idiopathic skeletal hypertrophy and degenerative disk disease by Roberts JA1, Wolfe TM.(PubMed)
(500) Medicinal herbs in the prevention and treatment of osteoporosis by Li C1, Li Q, Liu R, Niu Y, Pan Y, Zhai Y, Mei Q.(PubMed)
(501) New therapeutic potentials of milk thistle (Silybum marianum) by Milić N1, Milosević N1, Suvajdzić L1, Zarkov M2, Abenavoli L3.(PubMed)
(502) Milk thistle: a future potential anti-osteoporotic and fracture healing agent by Mohd Fozi NF, Mazlan M, Shuid AN, Isa Naina M1(PubMed)
(503) Osteoporotic fracture healing: potential use of medicinal plants from the tropics by Abdul Jalil MA, Shuid AN, Muhammad N1.(PubMed)
(504) Osteogenic activity of silymarin through enhancement of alkaline phosphatase and osteocalcin in osteoblasts and tibia-fractured mice by Kim JL1, Park SH, Jeong D, Nam JS, Kang YH.(PubMed)
(505) Osteoblastogenesis and osteoprotection enhanced by flavonolignan silibinin in osteoblasts and osteoclasts by Kim JL1, Kang SW, Kang MK, Gong JH, Lee ES, Han SJ, Kang YH.(PubMed)
(506) Piper sarmentosum: a new hope for the treatment of osteoporosis by Mohd Ramli ES, Suhaimi F, Ahmad F, Shuid AN, Mohamad N, Ima-Nirwana S1.(PubMed)
(507) Piper sarmentosum prevents glucocorticoid-induced osteoporotic bone resorption by increasing 11β-hydroxysteroid dehydrogenase type 1 activity by Suhana MR1, Farihah HS, Faizah O, Nazrun SA, Norazlina M, Norliza M, Nirwana SI.(PubMed)
(508) Histological changes in the fracture callus following the administration of water extract of piper sarmentosum(daun kadok) in estrogen-deficient rats by Estai MA1, Soelaiman IN, Shuid AN, Das S, Ali AM, Suhaimi FH.(PubMed)
(509) Role of medicinal plants and natural products on osteoporotic fracture healing by Abd Jalil MA1, Shuid AN, Muhammad N.(PubMed)
(510) Black cohosh (Cimicifuga spp.) for menopausal symptoms By Leach MJ1, Moore V.(PubMed)
(511) Actein isolated from black cohosh promotes the function of osteoblastic MC3T3-E1 cells by Lee YS1, Choi EM.(PubMed)
(512) Effects of remifemin treatment on bone integrity and remodeling in rats with ovariectomy-induced osteoporosis by Cui G1, Leng H2, Wang K3, Wang J3, Zhu S4, Jia J5, Chen X1, Zhang W3, Qin L3, Bai W1.(PubMed)
(513) Osteoprotective effects of Cimicifuga racemosa and its triterpene-saponins are responsible for reduction of bone marrow fat by Seidlova-Wuttke D1, Stecher G, Kammann M, Haunschild J, Eder N, Stahnke V, Wessels J, Wuttke W.(PubMed)
(514) The Effect of Labisia pumila var. alata on Postmenopausal Women: A Pilot Study by Azidah Abdul Kadir,1 Nik Hazlina Nik Hussain,1 Wan Mohammad Wan Bebakar,1 Dayang Marshitah Mohd,1 Wan Mohd Zahiruddin Wan Mohammad,1 Intan Idiana Hassan,2 Norlela Shukor,3 Nor Azmi Kamaruddin,3 and Wan Nazaimoon Wan Mohamud(Hindawi Publishing Corporation)
(515) The effects of Labisia pumila on postmenopausal osteoporotic rat model: Dose and time-dependent micro-CT analysis by Effendy NM1, Khamis MF2, Soelaiman IN1, Shuid AN1.(PubMed)
(516) Time and dose-dependent effects of Labisia pumila on the bone strength of postmenopausal osteoporosis rat model by Mohd Effendy N1, Abdullah S2, Yunoh MF3, Shuid AN4.(PubMed)
(517) Labisia pumila protects the bone of estrogen-deficient rat model: a histomorphometric study by Fathilah SN1, Nazrun Shuid A, Mohamed N, Muhammad N, Nirwana Soelaiman I.(PubMed)
(518) Efficacy of Tongkat Ali (Eurycoma longifolia) on erectile function improvement: Systematic review and meta-analysis of randomized controlled trials by Kotirum S1, Ismail SB2, Chaiyakunapruk N3.(PubMed)
(519) Effects of Eurycoma longifolia Jack (Tongkat Ali) on the initiation of sexual performance of inexperienced castrated male rats by Ang HH1, Cheang HS, Yusof AP.(PubMed)
(520) Phytoandrogenic properties of Eurycoma longifolia as natural alternative to testosterone replacement therapy by George A1, Henkel R.(PubMed)
(521) Eurycoma longifolia upregulates osteoprotegerin gene expression in androgen- deficient osteoporosis rat model by Shuid AN1, El-arabi E, Effendy NM, Razak HS, Muhammad N, Mohamed N, Soelaiman IN.(PubMed)
(522) The anti-osteoporotic effect of Eurycoma Longifolia in aged orchidectomised rat model by Shuid AN1, Abu Bakar MF, Abdul Shukor TA, Muhammad N, Mohamed N, Soelaiman IN.(PubMed)
(523) Phytoandrogenic properties of Eurycoma longifolia as natural alternative to testosterone replacement therapy by George A1, Henkel R.(PubMed)
(524) The effect of crude extract from Radix Dipsaci on bone in mice by Wong RW1, Rabie AB, Hägg EU.(PubMed)
(525) Radix Dipsaci total saponins stimulate MC3T3-E1 cell differentiation via the bone morphogenetic protein-2/MAPK/Smad-dependent Runx2 pathway by Niu YB1, Kong XH2, Li YH3, Fan L1, Pan YL1, Li CR1, Wu XL1, Lu TL1, Mei QB1.(PubMed)
(526) Therapeutic effects of radix dipsaci, pyrola herb, and Cynomorium songaricum on bone metabolism of ovariectomized rats by Liu M1, Xiao GG, Rong P, Zhang Z, Dong J, Zhao H, Li H, Li Y, Pan J, Liu H, Wang W, Zha Q, Ju D.(PubMed)
(527) Chemical Constituents, Quality Control, and Bioactivity of Epimedii Folium (Yinyanghuo) by Chen XJ1, Tang ZH1, Li XW1,2, Xie CX3, Lu JJ1, Wang YT1.(PubMed)
(528) Herba Epimedii: An ancient Chinese herbal medicine in the prevention and treatment of osteoporosis by Wang L, Li Y, Guo Y, Ma R, Fu M, Niu J, Gao S, Zhang D1.(PubMed)
(529)[Effects of active ingredients in three kidney-tonifying Chinese herbal drugs on gene expression profile of bone marrow stromal cells from a rat model of corticosterone-induced osteoporosis].
[Article in Chinese]by Bian Q1, Huang JH, Yang Z, Ning Y, Zhao YJ, Wang YJ, Shen ZY.(PubMed)
(530)
(531) Salvia miltiorrhiza: an ancient Chinese herbal medicine as a source for anti-osteoporotic drugs by Guo Y1, Li Y2, Xue L3, Severino RP3, Gao S1, Niu J2, Qin LP4, Zhang D5, Brömme D6.(PubMed)
(532) The correlation of Salvia miltiorrhiza extract-induced regulation of osteoclastogenesis with the amount of components tanshinone I, tanshinone IIA, cryptotanshinone, and dihydrotanshinone by Kim HK1, Woo ER, Lee HW, Park HR, Kim HN, Jung YK, Choi JY, Chae SW, Kim HR, Chae HJ.(PubMed)
(533) Osteoprotective effects of Fructus Ligustri Lucidi aqueous extract in aged ovariectomized rats by Chun Hay Ko, Wing Sum Siu, Ching Po Lau, ClaraBik San Lau, Kwok Pui Fung, Ping Chung Leung(Research Chinese Medicine December 2010, 5:39)
(534) Protective effects of water fraction of Fructus Ligustri Lucidi extract against hypercalciuria and trabecular bone deterioration in experimentally type 1 diabetic mice by Zhang Y1, Diao TY2, Wang L3, Che CT4, Wong MS5.(PubMed)
(535) Effects of the combined extracts of Herba Epimedii and Fructus Ligustri Lucidi on bone mineral content and bone turnover in osteoporotic rats by Liu RH1, Kang X2,3, Xu LP4, Nian HL5, Yang XW6, Shi HT7, Wang XJ8.(PubMed)
(536) Effect of the combined extracts of herba epimedii and fructus ligustri lucidi on sex hormone functional levels inosteoporosis rats by Liu R1, Kang X2, Xu L1, Nian H1, Yang X1, Shi H1, Wang X1.(PubMed)
(537) Du-Zhong (Eucommia ulmoides Oliv.) cortex extract prevent OVX-induced osteoporosis in rats by Zhang R1, Liu ZG, Li C, Hu SJ, Liu L, Wang JP, Mei QB.(PubMed)
(538) Effects of total lignans from Eucommia ulmoides barks prevent bone loss in vivo and in vitro. by Zhang R1, Pan YL2, Hu SJ3, Kong XH2, Juan W2, Mei QB4(PubMed)

(539) Eucommia ulmoides Oliv.: ethnopharmacology, phytochemistry and pharmacology of an important traditional Chinese medicine by He X1, Wang J2, Li M3, Hao D1, Yang Y4, Zhang C1, He R1, Tao R5.(PubMed)
(540) Osteoblasts proliferation and differentiation stimulating activities of the main components of Fructus Psoraleaecorylifoliae by Li WD1, Yan CP1, Wu Y1, Weng ZB1, Yin FZ2, Yang GM2, Cai BC3, Chen ZP4.(PubMed)
(541) Suppression of mast cell activity contributes to the osteoprotective effect of an herbal formula containing Herba Epimedii, Fructus Ligustri Lucidi and Fructus Psoraleae by Chan BC1, Lee HY, Siu WS, Yip KH, Ko CH, Lau CB, Leung PC, Lau HY.(PubMed)
(542) Treatment with qibaomeiran, a kidney-invigorating Chinese herbal formula, antagonizes estrogen decline in ovariectomized rats by Xu Y1, Ma XP, Ding J, Liu ZL, Song ZQ, Liu HN, Lin N.(PubMed)
(543) Bone protection effects of a novel Chinese herbal formula, Taikong Yangxin Prescription (), in hindlimb unloadedrats against bone deterioration by Ko CH1,2, Siu WS1,2, Chan CL1,2, Koon CM1,2, Fung KP1,2, Li YZ3, Li YH3, Leung PC4,5.
(544) Treatment with QiBaoMeiRan, a Chinese herbal formula, prevents bone loss in ovariectomized rat by Xu Y1, Ma X1, An J1, Ding J1, Dai G1, Liu Z2, Song Z2, Lin N1.(PubMed)
(545) Treatment with qibaomeiran, a kidney-invigorating Chinese herbal formula, antagonizes estrogen decline in ovariectomized rats by Xu Y1, Ma XP, Ding J, Liu ZL, Song ZQ, Liu HN, Lin N.(PubMed)
(546) Treatment with qibaomeiran, a kidney-invigorating Chinese herbal formula, antagonizes estrogen decline in ovariectomized rats by Xu Y1, Ma XP, Ding J, Liu ZL, Song ZQ, Liu HN, Lin N.(PubMed)
(547) Bu-Shen-Ning-Xin Decoction ameliorated the osteoporotic phenotype of ovariectomized mice without affecting the serum estrogen concentration or uterus by Wang L1, Qiu XM1, Gui YY1, Xu YP1, Gober HJ2, Li DJ3.(PubMed)
(548) Bu-Shen-Ning-Xin decoction: inhibition of osteoclastogenesis by abrogation of the RANKL-induced NFATc1 and NF-κB signaling pathways via selective estrogen receptor α by Wang L1, Qiu XM1, Gui YY1, Xu YP1, Gober HJ2, Li DJ3(PubMed)
(549) Bu-Shen-Ning-Xin decoction suppresses osteoclastogenesis via increasing dehydroepiandrosterone to preventpostmenopausal osteoporosis by Gui Y1, Qiu X, Xu Y, Li D, Wang L.(PubMed)
(550) In vivo screening for anti-osteoporotic fraction from extract of herbal formula Xianlinggubao in ovariectomized mice by Wang X1, He Y2, Guo B2, Tsang MC2, Tu F3, Dai Y3, Yao Z3, Zheng L2, Xie X2, Wang N4, Yao X3, Zhang G2, Qin L1.(PubMed)
(551) Phytoestrogen-rich herb formula "XLGB" prevents OVX-induced deterioration of musculoskeletal tissues at the hip in old rats by Qin L1, Zhang G, Hung WY, Shi Y, Leung K, Yeung HY, Leung P.(PubMed)
(552) A randomized, double-blind, controlled trial of a Chinese herbal formula (Er-Xian decoction) for menopausal symptoms in Hong Kong perimenopausal women by Zhong LL1, Tong Y, Tang GW, Zhang ZJ, Choi WK, Cheng KL, Sze SC, Wai K, Liu Q, Yu BX.(PubMed)
(553) Er-xian Decoction exerts estrogen-like osteoprotective effects in vivo and in vitro by Wong KC1, Lee KS, Luk HK, Wan HY, Ho CK, Zhang Y, Wong MS.(PubMed)
(554) Effects and interaction of icariin, curculigoside, and berberine in er-xian decoction, a traditional Chinese medicinal formula, on osteoclastic bone resorption by Xue L1, Jiao L, Wang Y, Nie Y, Han T, Jiang Y, Rahman K, Zhang Q, Qin L.(PubMed)


(555) Comparative effects of er-xian decoction, epimedium herbs, and icariin with estrogen on bone and reproductive tissue in ovariectomized rats by Xue L1, Wang Y, Jiang Y, Han T, Nie Y, Zhao L, Zhang Q, Qin L.(PubMed)
(556) The effects of Liuwei Dihuang on canonical Wnt/β-catenin signaling pathway in osteoporosis by Xia B1, Xu B2, Sun Y2, Xiao L3, Pan J3, Jin H4, Tong P5.(PubMed)
(557) The pharmacological effects of morroniside and loganin isolated from Liuweidihuang Wan, on MC3T3-E1 cells by Li M1, Wang W, Wang P, Yang K, Sun H, Wang X.(PubMed)






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