Wednesday, October 21, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoarthritis: The Diagnosis and Complications

By 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.

Osteoarthritis (OA), a form of arthritis, is defined as a condition of
as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone.


Diagnosis

According to the Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada, Screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations.

If you are experience certain symptom of osteoporosis, the tests which your doctor order include
1. Blood and urinary tests
The aim of the tests is to check for the bone metabolism and the progression of bone (loss) diseases.

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. with accurate result.

3. Quantitative Ultrasound and computed tomography (QCT)
Quantitative ultrasound (QUS) is a portable and accurate technology used to evaluate bone density at the lumbar spine and hip without the use of ionizing radiation.
Computed Tomography (CT) scanner.a technology for measuring properties of bone at peripheral skeletal sites(23).
Dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT), which are now the standard methods for assessing osteoporosis severity and treatment efficacy(24), but 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 discriminating between patients of differing prevalent vertebral fracture status(25).

4. Etc.

Complications associated with Osteoporosis
Pain, Fractures, Vertebral, Wrist, Rib fractures are associated with Osteoporosis, according to the study of New advances in imaging osteoporosis and its complications(26)
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References

(23) http://www.iscd.org/visitors/pdfs/10-QuantitativeUltrasoundintheMgmtofOsteo.pdf
(24) http://www.ncbi.nlm.nih.gov/pubmed/23154276
(25) http://www.ncbi.nlm.nih.gov/pubmed/23149277
(26) http://www.ncbi.nlm.nih.gov/pubmed/22618377

Tuesday, October 20, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoarthritis: The Diet

By 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.


Osteoarthritis (OA), a form of arthritis, is defined as a condition of
as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone.

The Diet
1. Green tea
Black tea polyphenol, theaflavin-3,3′-digallate (TFDG) and 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, according to study.

2. Organic soy
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, according to study.

3. Milk thistle seeds
Silibin found abundantly in Milk thistle seeds has shown to promote bone-forming osteoblastogenesis and encumber osteoclastic bone resorption in vitro cell systems of murine osteoblastic MC3T3-E1 cells and RAW 264.7 murine macrophages.

4. 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, according to study.

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoarthritis: The Causes of Risk Factors

By 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.

Osteoarthritis (OA), a form of arthritis, is defined as a condition of
as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone.
Causes of Risk Factors
A. Causes

1. Process of wear and repair
Osteoarthritis (OA) is a widespread degenerative disease of skeletal joints and is often associated with senescence in vertebrates. OA commonly results from excessive or abnormal mechanical loading of weight-bearing joints (‘wear-and-tear’), arising from heavy long-term use or specific injuries; yet, in the absence of injury, the aetiology of OA remains obscure(6)
Improper repair process of injure of joints can result of symptoms of Osteoarthritis (OA) in old age, according to TCM.
2. Nutrient deficiency
Poor nutritional conditions experienced by moose (Alces alces) early in life are linked to greater prevalence of OA during senescence as well as reduced life expectancy(7).
3. Cartilage
Cartilage is a flexible connective tissue which cushions the ends of bones in your joints and allows the joints to move smoothly. If the cartilage becomes rough or wears down due to aging or damage, it can causes pain as a result of bone in the joint rubbing against another bone.
The above causes of Osteoarthritis (OA) are the result of injure, overuse, Rheumatoid Arthritis, etc.
4. Etc.
B. Risk factors
Aging changes in the musculoskeletal system contribute to the development of OA by making the joint more susceptible to the effects of other OA risk factors that include abnormal biomechanics, joint injury, genetics, and obesity. Age-related sarcopenia and increased bone turnover may also contribute to the development of OA(8). Other suggested that Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury(8a).
1. Age and age related sarcopenis
Older adult are at increased risk of developing osteoarthritis as a result of muscular atrophy that occurs due aging. Normal aging in humans is associated with declines in skeletal muscle mass and strength and increased muscle fatigability (sarcopenia). These changes, together with the age-associated decline in whole-body exercise tolerance (VO2max), can substantially reduce the amount and intensity of physical activities performed by elderly (>60 y) men and women (Evans 1995)(9).
2. Gender and race
Women and Male Asian are at higher risk to develop osteoarthritis than men and male Caucasians, accordingly. The total prevalence of knee ROA was 24.3 % (CI 23.4-25.2 %). The whole prevalence in male patients was 24.3 % (CI 23.4-25.2 %); I2 = 59.4 (p = 0.002) and in female patients 32.6 % (CI 31.8-33.4 %); I2 = 49,1 (p < 0.001). Younger male patients (age 50-) had a prevalence of 5.6 (CI 4.5-6.8). In older patients (80+) the male prevalence was 44.5 % (CI 39.6-49.5 %). In this age group female patients had a prevalence of 71.6 % (CI 67.6-75.3 %). The higher prevalence of knee ROA in female patients was significant (OR = 1.8 [1.7-1.9]; I2 = 46.0 [p < 0.001]). The prevalence of knee ROA was higher in male Asians compared with male Asians compared with male Caucasians(OR = 1.1, CI 0.9-1.2; p = 0.080) in tendency. This difference was significant in female patients (OR = 2.2; CI 2.0-2.4; p < 0.001). Furthermore another trend was evaluated. Female patients (70-79 years) from the birth-year cohort 1920- had a prevalence of 37.8 % (CI 35.9-39.7)%. In contrast female patients from the birth-year cohort 1920 had a prevalence of 62.8 % (CI 60.8-64.8 %) at 70-79 years. This difference was significant (OR = 2.8; CI 2.5-3.1; p < 0.001), according to research of Praxisklinik für Unfallchirurgie und Orthopädie(10)
3. Deformation of bone
People who were born with defective joints or cartilage are at increased risk of developing osteoarthritis.
4. Activity
People who involve in activity such as sport are at higher risk to develop osteoarthritis.
5. Obesity
Researchers at the McMaster University in the study of Obesity and knee osteoarthritis showed that the potential mechanisms to link obesity and knee osteoarthritis, as both a biomechanical and metabolic condition are strongly linked. It has been established that weight loss for obese patients with knee osteoarthritis is clinically beneficial, for pain reduction, and for improved function. The exact mechanism linking obesity and osteoarthritis is complex; however, it is our opinion that further evidence supporting the link between the two diseases will be useful in providing clinicians and researchers with targets for physical therapy and pharmacological management of obese patients with knee osteoarthritis(11).
6. Occupations
Certain occupation are associated to the increased risk of osteoarthritis, especially to workers involving repetitive movements that stress on a particular joint. OA is potentially aetiologically linked to occupation in a sizeable segment of the population and that OA can no longer be considered an inevitable disease of ageing(12).
7. Genetics
Genetic studies have identified polymorphisms associated with osteoarthritis and related end-points. These include genes in signaling cascades involved in joint and bone biology, as well as genes in inflammatory pathways and a cluster of five genes in perfect linkage disequilibrium in the 7q22 region(13).
8. Deficiency in DNA repair
In the study of Analysis of osteoarthritis in a mouse model of the progeroid human DNA repair syndrome trichothiodystrophy, suggested that in premature aging TTD mice age-related changes in cartilage were not more severe compared to WT mice, in striking contrast with bone and many other tissues. This segmental aging character may be explained by a difference in vasculature and thereby oxygen load in cartilage and bone(14).
9. Other diseases and conditions may have a higher risk of developing the condition.
a. Gout
Gout is defined as a type of arthritis as a result of uric acid builds up in blood that leads to joint inflammation. Acute attacks of gout at individual joint sites are associated with the presence of clinically assessed OA. In a study of A total of 4249 completed questionnaires were returned (32%). From 359 attendees, 164 cases of gout were clinically confirmed. A highly significant association existed between the site of acute attacks of gout and the presence of OA (aOR 7.94; 95% CI 6.27, 10.05). Analysis at individual joint sites revealed a significant association at the first metatarsophalangeal joint (aOR 2.06; 95% CI 1.28, 3.30), mid-foot (aOR 2.85; 95% CI 1.34, 6.03), knee (aOR 3.07; 95% CI 1.05, 8.96) and distal interphalangeal joints (aOR 12.67; 95% CI 1.46, 109.91)(15)
b. Rheumatoid arthritis
Rheumatoid arthritis (RA) is defined as a chronic, systemic inflammatory disease that leads to the attack of flexible (synovial) joints, inflammation of the surrounding tissues and many tissues and organs. Rheumatoid arthritis (RA) cam cause progression of osteoarthritis in aging population.
c. Paget’s disease of the bone
Paget’s disease of bone is defined as a condition a chronic disorder that can lead to enlarged and misshapen bones resulting in excessive breakdown and formation of bone tissue causing pain, misshapen bones, fractures, and arthritis in the joints near the affected bones(16). Paget’s disease of bone (PDB) is a condition of unknown etiology characterized by excessive and abnormal bone remodeling. It may be localized to one or several skeletal segments. The disease seldom appears before the age of 40 years, but its prevalence tends to double each decade from the age of 50 onwards, reaching about 10% after ninth decade. PDB may virtually affect every bone in the skeleton. Affected bones are involved right away with no new involvement during the evolution. The basic symptom of the disease is bone pain, while complications depend on skeletal sites involved and range from secondary osteoarthritis to malignant degeneration(17).
d. Septic arthritis
Septic arthritis is a condition of inflammation of a joint as a result of bacterial or fungal infection of that it can lead to osteoarthritis. Others researchers suggest that joint sepsis should be considered if a patient with osteoarthritis develops new symptoms from a single joint with associated systemic features(18).
e. Etc.
9. Etc.
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Sources
(7) http://www.ncbi.nlm.nih.gov/pubmed/20618843
(8) http://www.ncbi.nlm.nih.gov/pubmed/20699160
(8a) http://www.ncbi.nlm.nih.gov/pubmed/17761605
(9) http://jn.nutrition.org/content/128/2/351S.full
(10) http://www.ncbi.nlm.nih.gov/pubmed/21243591
(11) http://www.ncbi.nlm.nih.gov/pubmed/22237485
(12) http://www.ncbi.nlm.nih.gov/pubmed/14573720
(13) http://www.ncbi.nlm.nih.gov/pubmed/20090528
(14) http://www.ncbi.nlm.nih.gov/pubmed/20820927
(15) http://www.ncbi.nlm.nih.gov/pubmed/17284542
(16) . http://en.wikipedia.org/wiki/Paget%27s_disease_of_bone
(17) http://www.ncbi.nlm.nih.gov/pubmed/18592244
(18) http://www.ncbi.nlm.nih.gov/pubmed/1958098

Monday, October 19, 2015

Most common diseases of 50 plus: Musculo-Skeletal Disorders – Osteoarthritis - The Symptoms

By 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.

Osteoarthritis
Osteoarthritis (OA), a form of arthritis, is defined as a condition of
as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone.

Symptoms
Symptoms of osteoarthritis is aching pain, stiffness, or difficulty moving the joint may develop in one or more joints. The pain usually gets worse in change of weather at night and in the advanced of the diseases the pain can occur even at rest.
1. Pain in joints of the hand
Most commonly affected joints of the hand in osteoarthritis include thecarpometacarpal joint of the thumb (CMC 1) and the distal (DIP) andproximal (PIP) interphalangeal joints. Ageing, female gender, genotype, heavy work causing pressure on the hands, and injuries predispose to osteoarthritis in the hand. The pain is likely to be due to secondary synovitis caused by molecules released from the joint cartilage(3).
2. Knee and Hip
Osteoarthritis (OA) of the knee and hip is among the most frequent and debilitating arthritic conditionsosteoarthritis. Key features of the pathological joint changes in OA include: cartilage destruction by pro-inflammatory cytokines, matrix metalloproteinases and prostaglandins, which promote a catabolic environment; subchondral bone remodelling and resorption; hypertrophic differentiation of chondrocytes; neovascularisation of synovial tissue; and focal calcification of joint cartilage(4).
3. Spine
Vertebral deformity, in particular wedging, of the thoracic spine is not exclusively characteristic for osteoporosis and that certain vertebral deformities develop by mechanisms other than fracture. Osteoporotic fracture of the thoracic spine is characterized by an exaggerated reduction of the midheight to posterior height in addition to reduction of the anterior to posterior height. Osteoarthritis affecting the low back can lead to chronic low back pain (lumbago) and degenerative disc disease (spondylosis).
Other researchers indicated that Postmenopausal women with lumbar spine disc degeneration are characterized by increased CII degradation. The contribution of lumbar spine disc space narrowing (DSN) to type II collagen (CII) degradation was similar to, and independent of, the contribution of radiologic knee OA or clinical hand OA. Lumbar spine disc degeneration in elderly patients should be assessed when analyzing levels of C-terminal crosslinking telopeptide of CII (CTX-II) in studies of knee, hip, and hand OA(5).

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References
(1) http://www.ncbi.nlm.nih.gov/pubmed/7864688
(2) http://health.yahoo.net/channel/musculoskeletal-disorders.html
(3) http://www.ncbi.nlm.nih.gov/pubmed/22448556
(4) http://www.ncbi.nlm.nih.gov/pubmed/22471357
(5) http://www.ncbi.nlm.nih.gov/pubmed/15476251

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoporosis Treatments In Traditional Chinese Medicine perspective

By 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.

Osteoporosis is condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time.


V. Treatments
C. In traditional Chinese medicine perspective
Osteoporosis in elder is defined as one of the conditions of the drop of Kidney Jing to certain level. As we age, our kidney doesn’t have the energy to nourish the bones, and they become weak and brittle, leading to the symptoms of earaches, ringing in the ears, hearing loss, hair loss, teeth problems, knee pain and lower back pain, loss of sex drive, including osteoporosis.
1. Du-Huo-Ji-Sheng-Tang and Du Zhong (Cortex Eucommiae)
Du-Huo-Ji-Sheng-Tang and Du Zhong (Cortex Eucommiae) were the most frequently prescribed herbal formula and single herb, respectively, for the treatment of osteoporosis, according to the study by the
Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital(47)
2. Zuogui Pill
In the study to reveal the mechanism of Zuogui Pill (see text) in treatment of glucocorticoid-induced osteoporosis from the angle of the Wnt signal transduction pathway and to provide further experimental evidence for expounding the scientific connotation of “the kidney dominating the bones” in TCM, found that Zuogui Pill can prevent and treat glucocorticoid-induced osteoporosis in rats by up-regulating the expression of the key signal molecules Wnt1, LRP-5 and beta-catenin in Wnt signal transduction pathway(48).
3. Embedding thread at Shenshu (BL 23)
In the study to observe the clinical effect of embedding thread at Shenshu (BL 23) for preventing and treating primary osteoporosis, found that BMDs of hip and lumbar vertebrae were both increased in the embedding thread group, and the BMDs of femoral neck and femoral trochanter in this group were significantly higher than those in the medication group (both P < 0.05). The rate of bone fracture during 5 years after treatment was 2.1% (1/48) in the embedding thread group, which was significantly lower than 18.2% (4/22) in the medication group (P < 0 05)(49).
4. Shaoyang Meridians
In the review to explore the theory of “Shaoyang Meridians being in charge of the bone” in Huangdi’s Internal Classic, which has been buried for long time, indicated that the theory of “Shaoyang Meridians being in charge of the bone” possibly first in the world recognizes osteoporosis being a general bony disease, and articulates that the Foot-Shaoyang Meradians can modulate bony strength under physiological and pathological conditions, and treat osteoporosis which mainly manifests as ostealgia and easy fracture(50).
5. Kidney-replenishing herbs (KRH)
In the study to investigate the effect of Kidney-replenishing herbs (KRH) on ovarian function of experimental rats with dexamethasone-induced osteoporosis (OP), showed that KRH could elevate the level of GH, LH, FSH, E2 and P, increase the weight and improve the histomorphologic features of ovary and uterus in OP rats(51).
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Sunday, October 18, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoporosis Treatments In Herbal medicine perspective

By 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.

Osteoporosis is condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time.

V. Treatments
B. In herbal medicine perspective
1. Red clover
In the study to test the combined effect of a quality-controlled red clover extract (RCE) standardized to contain 40% isoflavones by weight (genistein, daidzein, biochanin A, and formononetin present as hydrolyzed aglycones) together with a modified alkaline supplementation on bone metabolic and biomechanical parameters in an experimental model of surgically-induced menopause, showed that red clover preparation in dosages amenable to clinical practice do improve OVX-induced osteoporosis while a mild metabolic alkalosis might further synergize some therapeutic aspects(44).

2. Soy
In the study to to examine whether soybean protein isolate prevents bone loss induced by ovarian hormone deficiency, researchers at the Department of Human Nutrition and Dietetics, University of Illinois at Chicago, indicated that despite the higher rate of bone turnover in the soybean-fed animals, the vertebral and femoral bone densities of these rats were significantly greater than those of rats in the ovx group, suggesting that formation exceeded resorption(45).

3. Soybeans, clover and alfalfa sprouts, and oilseeds (such as flaxseed)
Studies in humans, animals, and cell culture systems suggest that dietary phytoestrogens found in Soybeans, clover and alfalfa sprouts, and oilseeds (such as flaxseed) play an important role in prevention of menopausal symptoms, osteoporosis, cancer, and heart disease(46). 

Saturday, October 17, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoporosis Treatments In conventional medicine perspective

By 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.

Osteoporosis is condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time.

V. Treatments
A. In conventional medicine perspective
A.1. Bisphosphonates
1. Including Alendronate (Fosamax), Risedronate (Actonel, Atelvia), Ibandronate (Boniva), Zoledronic acid (Reclast, Zometa), etc..Bisphosphonates are antiresorptive medications widely prescribed for treating osteoporosis. In placebo-controlled clinical trials they have been shown to significantly reduce the risk of osteoporotic fractures(36).
Others suggested that Because bisphosphonate accumulate in bone and provide some residual antifracture reduction when treatment is stopped, we recommend a drug holiday after 5-10 yr of bisphosphonate treatment. The duration of treatment and length of the holiday are based on fracture risk and pharmacokinetics of the bisphosphonate used. Patients at mild risk might stop treatment after 5 yr and remain off as long as bone mineral density is stable and no fractures occur. Higher risk patients should be treated for 10 yr, have a holiday of no more than a year or two, and perhaps be on a nonbisphosphonate treatment during that time(37).

2. Side effects
a. Nausea
b. Abdominal pain
c. Difficulty swallowing
d. Rrisk of an inflamed esophagus or esophageal ulcers(38)
e. Risk of scleritis and a variety of ocular side effects(39)
f. Etc.
2. Hormone-related therapy
Hormone replacement therapy can help to maintain bone density for menopause women, but it increases
a, The risk of breast cancer and heart disease(40)
b. The risk for venous thromboembolism(41)
c. The risk of (Nonmelanoma Skin Cancers) NMSC.(42)
d. The risk of stroke(43)
e. etc.
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