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Types of Musculo-Skeletal disorders in elder(2)
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
7. Low back pain
A. In conventional medicine perspective
The osteoporosis Canada suggested the following treatment for patient with osteoporosis depending to differentiation(350).
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
2.2. 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)
2.8. 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).
2. Hormone replacement therapy can help to maintain bone density for menopause women, but it increases
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).
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).
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(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) Osteoporosis(Life extension)
(4) Hormone and bone by Francisco Bandeira1, Marise Lazaretti-Castro2, John P. Bilezikian3
(5) Growth hormone and bone by Ohlsson C1, Bengtsson BA, Isaksson OG, Andreassen TT, Slootweg MC.(PubMed)
(6) GH and bone--experimental and clinical studies by Isaksson OG1, Ohlsson C, Bengtsson BA, Johannsson G.(PubMed)