Osteoporosis Health Dictionary

This is the term applied to the cessation of MENSTRUATION at the end of reproductive life. Usually it occurs between the ages of 45 and 50, although it may occur before the age of 30 or after the age of 50. It can be a psychologically disturbing experience which is quite often accompanied by physical manifestations. These include hot ?ushes, tiredness, irritability, lack of concentration, palpitations, aching joints and vaginal irritation. There may also be loss of libido (sex drive). Most women can and do live happy, active lives through the menopause, the length of which varies considerably.

One of the major problems of the menopause which does not give rise to symptoms until many years later is osteoporosis (see BONE, DISORDERS OF). After the menopause, 1 per cent of the bone is lost per annum to the end of life. This is a factor in the frequency of fractures of the femur in elderly women as a result of osetoporosis, but it can be prevented by hormone replacement therapy (see below).

Hormone replacement therapy (HRT) This term has become synonymous with the scienti?cally correct term ‘OESTROGENS replacement therapy’ to signify the treatment of menopausal symptoms and signs with oestrogens, now usually combined with PROGESTOGEN. Oestrogen and combined treatment relieve the short-term symptoms such as hot ?ushes, sweats and vaginal dryness. Atrophic vaginitis and vulvitis (shrinking of the tissues of VULVA and VAGINA due to fall in natural oestrogen levels) also usually respond to treatment with oestrogens.

Cyclical therapy is necessary to avoid abnormal bleeding in women who have reached the menopause. If oestrogens are given alone, there is an increased risk of endometrial hyperplasia (overgrowth of the ENDOMETRIUM) which may lead to endometrial cancer, so these are restricted to women who have had a hysterectomy and are no longer at risk. Other women can be given oestrogen-progestogen combinations.

There is good evidence that oestrogen alone or in combination can prevent the bone-loss associated with the menopause by reducing the demineralisation of bone which normally occurs after the menopause; and, if it is started early and continued for years, it may prevent the development of osteoporosis. Oestrogen is far more e?ective than calcium supplements and has been shown greatly to reduce fractures affecting the spine, wrists and legs after the age of 50.

However, HRT is no longer licensed for ?rst-line treatment to prevent osteoporosis, as increased risk of stroke, breast cancer and coronary heart disease cannot justify treatment for long periods – unless the woman has severe menopausal symptoms. HRT is recommended for short-term use only in menopausal women whose lives are inconvenienced by vasomotor instability (severe ?ushes, etc.) or vaginal atrophy, although the latter may respond to local oestrogen treatment – creams or pessaries. In terms of oestrogenic activity, natural oestrogen such as oestradiol, oestrone and oestriol are more appropriate for HRT than synthetic oestrogens like ethinyloestradiol, mestranol and diethylstilboestrol.

Many experts believe that controversy surrounding the risks and bene?ts of HRT have been settled by a large randomised trial (the Women’s Health Initiative), published in 2003, which showed that combined treatment increases the risk of breast tumours, stroke and coronary heart disease (in the ?rst year). Oestrogen alone (given to women who have had a hysterectomy) also increases the risk of stroke. Five years of combined treatment may double the risk of breast cancer, and the heart-disease risk is nearly doubled during the ?rst year of use. This is in spite of the bene?cial effects of HRT on blood lipids. However, there are others who consider that di?erent dose combinations of di?erent hormones may one day prove bene?cial, so research continues.

HRT can also provoke minor adverse effects such as breast tenderness, ?uid retention, leg cramps and nausea. The risk of abnormal blood clotting means that HRT is not normally recommended for women who smoke heavily or have had THROMBOSIS, severe HYPERTENSION, stroke or liver disease. HRT has, however, brought symptomatic bene?ts to many menopausal women, who can then justify taking the other increased risks – only fully understood since the large trial results were published.

As the evidence stands at present, careful consideration of each woman’s medical history and the severity of her menopausal symptoms is necessary in deciding what combination of drugs should be given and for how long. In general, the indications should be severe menopausal symptoms that can be controlled by the lowest dose for the shortest time. Using HRT to alleviate mild symptoms, or to prevent future bone loss, is probably of insu?cient bene?t to counter the other risks described above.... menopause

Bisphosphonates, of which disodium etidronate is one, are a group of drugs used mainly in the treatment of PAGET’S DISEASE OF BONE and in established vertebral osteoporosis (see BONE, DISORDERS OF). Their advantage over CALCITONIN (which has to be given by subcutaneous or intramuscular injection) is that they can be taken orally. They act by reducing the increased rate of bone turnover associated with the disease. Disodium etidronate is used with calcium carbonate in a 90-day cycle (duration of therapy up to three years) in the treatment of osteoporosis.... bisphosphonates

Bone is not an inert sca?olding for the human body. It is a living, dynamic organ, being continuously remodelled in response to external mechanical and chemical in?uences and acting as a large reservoir for calcium and phosphate. It is as susceptible to disease as any other organ, but responds in a way rather di?erent from the rest of the body.

Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.

SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.

The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.

HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper

limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.

Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.

Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.

The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.

Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.

with plaster of Paris. If closed traction does not work, then open reduction of the fracture may

be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.

External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.

Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.

Complications of fractures are fairly common. In non-union, the fracture does not unite

– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.

Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.

Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:

subcapital where the neck joins the head of the femur.

intertrochanteric through the trochanter.

subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur

need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.

In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.

Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.

Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.

The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.

Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).

Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.

Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.

Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.

By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.

Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.

Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.

Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.

Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.

With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.

Further information is available from the National Osteoporosis Society.

Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.

If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.

For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.

Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.

EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.

MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.

OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.

OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of

Most people suffer from backache at times during their lives, much of which has no identi?able cause – non-speci?c back pain. This diagnosis is one of the biggest single causes of sickness absence in the UK’s working population. Certain occupations, such as those involving long periods of sedentary work, lifting, bending and awkward physical work, are especially likely to cause backache. Back pain is commonly the result of sporting activities.

Non-speci?c back pain is probably the result of mechanical disorders in the muscles, ligaments and joints of the back: torn muscles, sprained LIGAMENTS, and FIBROSITIS. These disorders are not always easy to diagnose, but mild muscular and ligamentous injuries are usually relieved with symptomatic treatment – warmth, gentle massage, analgesics, etc. Sometimes back pain is caused or worsened by muscle spasms, which may call for the use of antispasmodic drugs. STRESS and DEPRESSION (see MENTAL ILLNESS) can sometimes result in chronic backache and should be considered if no clear physical diagnosis can be made.

If back pain is severe and/or recurrent, possibly radiating around to the abdomen or down the back of a leg (sciatica – see below), or is accompanied by weakness or loss of feeling in the leg(s), it may be caused by a prolapsed intervertebral disc (slipped disc) pressing on a nerve. The patient needs prompt investigation, including MRI. Resting on a ?rm bed or board can relieve the symptoms, but the patient may need a surgical operation to remove the disc and relieve pressure on the affected nerve.

The nucleus pulposus – the soft centre of the intervertebral disc – is at risk of prolapse under the age of 40 through an acquired defect in the ?brous cartilage ring surrounding it. Over 40 this nucleus is ?rmer and ‘slipped disc’ is less likely to occur. Once prolapse has taken place, however, that segment of the back is never quite the same again, as OSTEOARTHRITIS develops in the adjacent facet joints. Sti?ness and pain may develop, sometimes many years later. There may be accompanying pain in the legs: SCIATICA is pain in the line of the sciatic nerve, while its rarer analogue at the front of the leg is cruralgia, following the femoral nerve. Leg pain of this sort may not be true nerve pain but referred from arthritis in the spinal facet joints. Only about 5 per cent of patients with back pain have true sciatica, and spinal surgery is most successful (about 85 per cent) in this group.

When the complaint is of pain alone, surgery is much less successful. Manipulation by physiotherapists, doctors, osteopaths or chiropractors can relieve symptoms; it is important ?rst to make sure that there is not a serious disorder such as a fracture or cancer.

Other local causes of back pain are osteoarthritis of the vertebral joints, ankylosing spondylitis (an in?ammatory condition which can severely deform the spine), cancer (usually secondary cancer deposits spreading from a primary tumour elsewhere), osteomyelitis, osteoporosis, and PAGET’S DISEASE OF BONE. Fractures of the spine – compressed fracture of a vertebra or a break in one of its spinous processes – are painful and potentially dangerous. (See BONE, DISORDERS OF.)

Backache can also be caused by disease elsewhere, such as infection of the kidney or gall-bladder (see LIVER), in?ammation of the PANCREAS, disorders in the UTERUS and PELVIS or osteoarthritis of the HIP. Treatment is e?ected by tackling the underlying cause. Among the many known causes of back pain are:

Mechanical and traumatic causes

Congenital anomalies. Fractures of the spine. Muscular tenderness and ligament strain. Osteoarthritis. Prolapsed intervertebral disc. Spondylosis.

In?ammatory causes

Ankylosing spondylitis. Brucellosis. Osteomyelitis. Paravertebral abscess. Psoriatic arthropathy. Reiter’s syndrome. Spondyloarthropathy. Tuberculosis.

Neoplastic causes

Metastatic disease. Primary benign tumours. Primary malignant tumours.

Metabolic bone disease

Osteomalacia. Osteoporosis. Paget’s disease.

Referred pain

Carcinoma of the pancreas. Ovarian in?ammation and tumours. Pelvic disease. Posterior duodenal ulcer. Prolapse of the womb.

Psychogenic causes

Anxiety. Depression.

People with backache can obtain advice from www.backcare.org.uk... backache

A SERUM concentration of calcium below the normal range (between 2.33 and 3.05 mmol of calcium per 100 ml of serum). This may cause TETANY, acutely; chronically it may give rise to RICKETS, OSTEOMALACIA or osteoporosis (see BONE, DISORDERS OF). It may be caused by hypoparathyroidism (see THYROID GLAND, DISEASES OF), vitamin D de?ciency (see APPENDIX 5: VITAMINS), malabsorption, renal failure or acute pancreatitis (see PANCREAS, DISORDERS OF).... hypocalcaemia

A radiological technique for detecting osteoporosis (see BONE, DISORDERS OF) in which a beam of X-rays is directed at the bone-area under investigation – normally the spine and hip – and the CALCIUM density measured. If the calcium content is low, preventive treatment can be started to reduce the likelihood of fractures occurring.... quantitative digital radiography

A drug used to prevent and treat postmenopausal osteoporosis (see under BONE, DISORDERS OF). Its action di?ers from hormone-replacement drugs in that it does not modify the symptoms of the MENOPAUSE.... raloxifene

Diminution in the density of a BONE as a result of withdrawal of calcium salts from it. (See BONE, DISORDERS OF – Osteoporosis.)... rarefaction

A hormonal disorder caused by an abnormally high level of corticosteroid hormones in the blood. Cushing’s syndrome is characterized by a red moon-shaped face, wasting of the limbs, thickening of the trunk, and a humped upper back. Other symptoms

include acne, stretch marks, bruising, weakening of the bones by osteoporosis, susceptibility to infection and peptic ulcers, and, in women, increased hairiness. Mental changes frequently occur, causing depression, insomnia, paranoia, or, euphoria. Hypertension, oedema, and diabetes mellitus may develop. In children, growth may be suppressed.

The excess hormones are most commonly due to prolonged treatment with corticosteroid drugs. Such cases of Cushing’s syndrome are usually mild. In other cases, high hormone levels are due to overactivity of the adrenal glands as a result of an adrenal tumour, or of a pituitary tumour affecting production of ACTH (adrenocortocotrophic hormone), which stimulates the adrenal glands.

Cushing’s syndrome caused by corticosteroid drugs usually disappears if the dose is gradually reduced.

A tumour of an adrenal gland is removed surgically.

A pituitary tumour may be removed surgically or shrunk by irradiation and drug treatment.

In both cases, surgery is followed by hormone replacement therapy.... cushing’s syndrome

(HRT) The use of a synthetic or natural hormone to treat a hormone deficiency.Most commonly, refers to the use of female hormones to relieve symptoms associated with the menopause, such as hot flushes and vaginal dryness. also reduces the risk of the long-term effects associated with low oestrogen levels, such as osteoporosis. An oestrogen is usually taken in combination with a progestogen. The hormones may be taken orally or released into the bloodstream from a hormonal implant, skin patch, or gel.

Minor adverse effects of include nausea, breast tenderness, fluid retention, and leg cramps. In some women, oestrogen therapy may increase the risk of abnormal blood clotting. Women taking in the long term are thought to be at a slightly increased risk of breast cancer, but are thought to be less likely to develop coronary artery disease.... hormone replacement therapy

A bisphosphonate drug used in the treatment of osteoporosis and Paget’s disease of bone. The most common side effect is inflammation of the oesophagus, which causes heartburn or difficulty in swallowing. Other side effects can include headache and abdominal pain.... alendronic acid

Heparin is one of the naturally produced ANTICOAGULANTS with a rapid e?ect, which is thought to act by neutralising thrombin (see COAGULATION). Inactive when taken orally, it is normally given intravenously – it may be given for a few days, combined with an oral anticoagulant such as warfarin, to initiate anticoagulation. Low-dose heparin may be given by subcutaneous injection for longer periods, for the prophylaxis of DEEP VEIN THROMBOSIS (DVT) or PULMONARY EMBOLISM in ‘high-risk’ patients, such as those with obesity or a history of thrombosis, or post-operatively. If haemorrhage occurs, withdrawal of heparin is usually su?cient, but protamine sulphate is a rapidly active and speci?c antidote. Prolonged treatment with heparin may cause osteoporosis (see under BONE, DISORDERS OF).... heparin

Agaricus tea is the beverage resulting from brewing the dried Agaricus mushrooms. Cultivated for culinary purposes, this tea has healing properties which enable it to be an important ingredient in the pharmaceutical industries. About Agaricus Tea Agaricus is a species of mushroom, growing locally in Asia, Europe and South America. It is also known as the “mushroom of life” or “God’s mushroom” and is appreciated for its health properties. The Agaricus mushroom is bulbous at the base, its flesh has a nut-like taste while its scent is akin to almonds. It is regularly added to salads, stir fries, pastas, sauces, soups, pies and breakfasts. Agaricus Tea is obtained by brewing the above mentioned mushroom. Brewing Agaricus Tea When brewing Agaricus Tea, it is recommended to use a non aluminum pot or teapot. 750ml is enough for 3 cups taken throughout the day: 1 cup in the morning, 1 cup in the afternoon and 1 cup in the evening.

• place about 5 grams of mushrooms in 1 liter of cold water
•  let the mushrooms soak in 1 liter of water until they are re-hydrated
• when the mushrooms are dry and you start to boil the water, they will just float on top and will not extract as quickly
• bring the mixture to a boil
• once it starts to boil, reduce the flame and let it simmer at low flame for about 20 to 30 minutes until the mixture has been reduced about 1/4 or when you have about 750ml of liquid left
• let the mixture cool

Agaricus Tea could be served cold or hot. Agaricus Tea benefits Agaricus Tea is a great source of nutrition, providing a full range of vitamins, minerals, carbohydrates and proteins, important for human health. It has been acknowledged that Agaricus tea may reduce the risk of tumors and cancer due to the antioxidant action which enhance the immune system. Agaricus tea is part of the anti-cancer treatment regimen in both Brazil and Japan. This tea is successfully used as a helping tool in:

• lowering the diabetes risk
• lowering the risk of cardiovascular ailments
• mitigating stomach ulcers and ulcerative colitis
• fighting against osteoporosis
• reducing digestive ailments
• fighting against diseases affecting the bloodstream

Agaricus tea is believed to help in reducing radiation damage. Agaricus Tea side effects Agaricus tea is considered safe, non-toxic and well tolerated by the majority of the population. Further studies should be conducted in order to establish if Agaricus tea can actually cause liver damage when taken in clinical doses. Agaricus tea is an important immune enhancer and energy booster. It provides the needed help in weight management and could be successfully included in diets through tasty salads or sauces.... agaricus tea: a mushroom tea

The result of a combination of natural, largely genetically programmed changes occurring in all body systems. Diseases or injuries may in?uence these changes, which impair the body’s homeostatic mechanisms; environment and lifestyle also affect the ageing process.

The effects of ageing include: cessation of MENSTRUATION in females; wrinkling of the skin due to a loss of elastic tissue; failing memory (especially short term) and a reduced ability to learn new skills, along with slowed responses

– changes caused by the loss of or less e?cient working of nerve cells; the senses become less acute; the lungs become less e?cient, as does heart muscle, both causing a fall in exercise tolerance; arteries harden, resulting in a rise in blood pressure and poor blood circulation; joints are less mobile, bones beome more brittle (OSTEOPOROSIS) and muscle bulk and strength are reduced; the lens of the EYE becomes less elastic, resulting in poorer sight, and it may also become opaque (CATARACT).

In developed countries people are living longer, in part because infant and child mortality rates have dropped dramatically over the past 100 years or so. Improved standards of living and more e?ective health care have also contributed to greater longevity: the proportion of people over 65 years of age has greatly increased, and that of the over-75s is still rising. The 2001 census found 336,000 people in the UK aged over 90 and there are 36,000 centenarians in the US. This extreme longevity is attributed to a particular gene (see GENES) slowing the ageing process. Interestingly, those living to 100 often retain the mental faculties of people in their 60s, and examination of centenarians’ brains show that these are similar to those of 60-year-olds. (See MEDICINE OF AGEING; CLIMACTERIC.)

Help and advice can be obtained from Age

Concern and Help the Aged. See www.helpthaged.org.uk www.ageconcern.org.uk... ageing

A salt of the element CALCIUM used to treat de?ciency of the mineral or to prevent osteoporosis (see BONE, DISORDERS OF). Tablets can be obtained without a doctor’s prescription. It is used intravenously to treat low calcium levels causing symptoms in newborn babies.... calcium gluconate

Also known as disodium etidronate, this is one of a group of substances called biphosphates used mainly to treat PAGET’S DISEASE OF BONE. The drug is given orally and, when combined with calcium carbonate (Didrone®), it is used to treat osteoporosis (see under BONE, DISORDERS OF) and to prevent bone loss in postmenopausal women, especially if hormone replacement therapy (HRT – see under MENOPAUSE) is not appropriate.... etidronate

The thigh bone, which is the longest and strongest bone in the body. As the upper end is set at an angle of about 120 degrees to the rest of the bone, and since the weight of the body is entirely borne by the two femora, fracture of one of these bones close to its upper end is a common accident in old people, whose bones are often weakened by osteoporosis (see under BONE, DISORDERS OF). The femur ?ts, at its upper end, into the acetabulum of the pelvis, forming the hip-joint, and, at its lower end, meets the tibia and patella in the knee-joint.... femur

The nitrogen-retaining e?ect of ANDROGEN, a steroid hormone, is responsible for the larger muscle mass of the male. This is called an anabolic e?ect. Attempts have been made to separate the anabolic effects of hormones from their virilising effects (see VIRILISATION), but these have been only partially successful. Thus, anabolic steroids have the property of protein-building so that when taken, they lead to an increase in muscle bulk and strength. All the anabolic steroids have some androgenic activity but they cause less virilisation than androgens in women. Androgenic side-effects may result from any of these anabolic compounds, especially if they are given for prolonged periods: for this reason they should all be used with caution in women, and are contraindicated in men with prostatic carcinoma. Jaundice due to stasis of bile in the intrahepatic canaliculi is a hazard, and the depression of pituitary gonadotrophin production is a possible complication.

Anabolic steroids have been used to stimulate protein anabolism in debilitating illness, and to promote growth in children with pituitary dwar?sm and other disorders associated with interference of growth. Stimulation of protein anabolism may also be of value in acute renal failure, and the retention of nitrogen and calcium is of probable bene?t to patients with OSTEOPOROSIS and to patients receiving corticosteroid therapy. Anabolic steroids may stimulate bone-marrow function in hypoplastic ANAEMIA.

They have been widely abused by athletes and body-builders aiming to improve their strength, stamina, speed or body size. However, there are considerable doubts over their e?cacy, with little experimental evidence that they work. Dangerous adverse effects include precocious myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis), DIABETES MELLITUS, liver disease, precocious carcinoma of the prostate, acne, and severe psychiatric disorders. Anabolic steroids should not be used by athletes, who face bans from o?cial competitions if they take them.

The anabolic steroids in therapeutic use include nandrolone and stanozolol.... anabolic steroids

Linn.

Family: Acanthaceae.

Habitat: Western Ghats, West Coast from Konkan to Kerala; abundant in the rainy season.

Ayurvedic: Parpata (substitute).

Action: The plant contains naphthofuranones, justicidin A, B, C, D, G and H, and diphyllin, which are used for the treatment of osteoporosis. The flowers contain peonidine glucoside. Essential oil— antifungal.... justicia procumbens

Black Cohosh tea is recommended to people who want to prevent bone ailments or just to enhance their immune system. Black Cohosh Tea description Black Cohosh is a woodland plant, found in the New England region of the United States, as well as eastern Canada. Its roots and rhizomes are used for medicinal properties, particularly for female hormonal balance and arthritis. It also has acknowledged anti-inflammatory and antispasmodic properties. Black cohosh can be consumed as a fresh or dry root or as a supplement in liquid or tablet forms. The daily dosage should not exceed 80 mg Black cohosh in tablet form or 2 to 4 ml Black Cohosh tincture two to three times a day. Black Cohosh tea is the resulting beverage from brewing the abovementioned plant. Black Cohosh Tea brewing To make Black Cohosh tea, use the roots of the plant. Black Cohosh roots should be boiled for about 20 to 30 minutes in water. Strain it and drink it slowly. Black Cohosh Tea benefits Studies revealed Black Cohosh tea to be efficient in treating:

• the symptoms of menopause and menstrual discomfort (hot flashes, mood swings and vaginal dryness)
• infertility
• rheumatism
• cough
• high cholesterol levels, as well as hardening of the arteries
• osteoporosis
• muscle aches

Black Cohosh side effects Black Cohosh tea is not recommended during pregnancy, as large doses may induce a miscarriage. An overdose can cause dizziness, nausea and increased perspiration. Also, Black Cohosh tea may cause gastrointestinal pain, diarrhea, vomiting and nausea. People intaking  this type of tea may experience dizziness, headaches, tremors and a slow heart rate. Individuals with an allergy to buttercup or crowfoot should avoid Black Cohosh tea because they are from the same plant family. People who are allergic to aspirin should not consume the tea because it contains small amounts of salicylic acid, the active ingredient in aspirin. Also people with a history of blood clots, seizures and high blood pressure should avoid Black Cohosh tea. Black Cohosh tea is known for its anti-inflammatory and antispasmodic action, being successfully used to treat women health issues such as menopause and menstrual discomfort.... black cohosh tea: benefic in menopause

Around one in 100 people suffers from coeliac disease, a condition in which the small INTESTINE fails to digest and absorb food, but many have no or few symptoms and remain undiagnosed. The intestinal lining is permanently sensitive to the protein gliadin (an insoluble and potentially toxic PEPTIDE protein) which is contained in GLUTEN, a constituent of the germ of wheat, barley and rye. As bread or other grain-based foods are a regular part of most people’s diet, the constant presence of gluten in the intestine of sufferers of coeliac disease causes atrophy of the digestive and absorptive cells of the intestine. Children are usually diagnosed when they develop symptoms such as vomiting, diarrhoea, lethargy, ANAEMIA, swollen abdomen and pale, frothy, foul-smelling faeces with failure to thrive. The diagnosis is usually made by a positive blood antibody test such as antiendomysial antibodies. However, because there may be an occasional false positive result, the ‘gold standard’ is to obtain a biopsy of the JEJUNUM through a tiny metal capsule that can be swallowed, a specimen taken, and the capsule retrieved. Though coeliac disease was long thought to occur in childhood, a second peak of the disorder has recently been identi?ed among people in their 50s.

Not all sufferers from coeliac disease present with gastrointestinal symptoms: doctors, using screening techniques, have increasingly identi?ed large numbers of such people. This is important because researchers have recently discovered that untreated overt and silent coeliac disease increases the risk of sufferers developing osteoporosis (brittle bone disease – see BONE, DISORDERS OF) and cancer. The osteoporosis develops because the bowel fails to absorb the CALCIUM essential for normal bone growth. Because those with coeliac disease lack the enzyme LACTASE, which is essential for digesting milk, they avoid milk – a rich source of calcium.

The key treatment is a strict, lifelong diet free of gluten. As well as returning the bowel lining to normal, this diet results in a return to normal bone density. People with coeliac disease, or parents or guardians of affected children, can obtain help and guidance from the Coeliac Society of the United Kingdom. (See also MALABSORPTION SYNDROME; SPRUE.)... coeliac disease

Osteoporosis (see under BONE, DISORDERS OF) in the hand or foot which develops quickly as a result of injury, infection or malignant growth.... sudek’s atrophy

A term applied to a group of symptoms occurring together regularly, and thus constituting a disease to which some particular name is given: for example, CUSHING’S SYNDROME comprising obesity, hypertension, purple striae and osteoporosis; or KORSAKOFF’S SYNDROME, comprising loss of appreciation of time and place combined with talkativeness, forming signs of alcoholic delirium.... syndrome

Trace element. Imparts ‘tone’ to walls of blood vessels and muscles.

Deficiency. A diet deficient in Fluorine induces relaxed conditions: varicose veins, weak ligaments. Bone-wasting diseases – osteoporosis, dental decay.

Body effects. Maintains vascular, bone and dental health.

Sources. Meat, fish (where bones are consumed) sardines, salmon. Plants: Garlic, Watercress.

Note: Excess causes: fluorosis – mottling of teeth, arthritic joints and increased density of the bones. Controversial government policy promotes addition of Sodium flouride to water to achieve a minimum of one part per million. ... fluorine

The performance of any physical activity that improves health or that is used for recreation or for the correction of physical injury or deformity (see physiotherapy). Different types of exercise have different effects on the body. During aerobic exercise, such as jogging or swimming, the heart and lungs work faster and more efficiently to supply the muscles’ increased demand for oxygen; regular aerobic exercise improves the condition of both the cardiovascular and respiratory systems. Exercises such as weight training increase muscle strength and endurance. Activities such as yoga and pilates improve flexibility.

Regular aerobic exercise usually leads to a reduction in blood pressure. It also results in an increased amount of highdensity lipoprotein (HDL) in the blood, which is thought to help protect against atherosclerosis and myocardial infarction. Exercise can relieve the symptoms of peripheral vascular disease and of some psychological disorders, particularly depression. Regular weightbearing exercise, such as running, increases the density of, and thereby strengthens, the bones. The bone disease osteoporosis is less common in people who have exercised throughout their adult lives.

However, vigorous exercise may cause injury and increase the risk of a heart attack in people who are out of condition.

Professional sportsmen such as footballers have an increased risk of osteoarthritis in later life because of repeated minor damage to the joints.... exercise

The tendency to fall increases steadily with age. Reflex actions become slower, and an elderly person who trips is frequently too slow to prevent a fall. Various medical conditions common in the elderly, including poor sight, walking disorders, cardiac arrhythmias, hypotension, and Parkinson’s disease, increase the risk of falls, as does taking sleeping drugs or tranquillizer drugs.

Broken bones (see fracture) are a common complication of falls, especially in women. Not only do women have more falls, they are also more likely to suffer fractures because their bone strength may be reduced due to osteoporosis. A fall, or the fear of falling, can also have adverse psychological effects on an elderly person, who may become reluctant to leave the home.

Falls may be prevented by taking common-sense measures such as ensuring that handrails are secure, good lighting is available, suitable footwear is worn, and floor coverings and wiring are safe.... falls in the elderly

The symptoms, treatment, and possible complications of a fracture of the femur (thigh-bone) depend on whether the bone has broken across its neck (the short section between the top of the shaft and the hip joint) or across the shaft.Fracture of the neck of the femur, often called a broken hip, is very common in elderly people, especially in women with osteoporosis, and is usually associated with a fall. In a fracture of the neck of the femur, the broken bone ends are often considerably displaced; in such cases there is usually severe pain in the hip and groin, making standing impossible. Occasionally, the broken ends become impacted. In this case, there is less pain and walking may be possible. Diagnosis is confirmed by X-ray. If the bone ends are displaced, an operation under general anaesthesia is necessary, either to realign the bone ends and to fasten them together, or to replace the entire head and neck of the femur with an artificial substitute (see hip replacement). If the bone ends are impacted the fracture may heal naturally, but surgery may still be recommended to avoid the need for bed rest.

Complications include damage to the blood supply to the head of the femur, causing it to disintegrate. Osteoarthritis may develop in the hip joint after fracture of the femur neck itself. However, immobility and the need for surgery in the elderly may result in complications, such as pneumonia, that are not directly related to the fracture site.

Fracture of the bone shaft usually occurs when the femur is subjected to extreme force, such as that which occurs in a traffic accident. In most cases, the bone ends are considerably displaced, causing severe pain, tenderness, and swelling.

Diagnosis is confirmed by X-ray. With a fractured femoral shaft there is often substantial blood loss from the bone. In most cases, the fracture is repaired by surgery in which the ends of the bone are realigned and fastened together with a metal pin. Sometimes the bone ends can be realigned by manipulation, and surgery is not necessary. After realignment, the leg is supported with a splint and put in traction to hold the bone together while it heals.

Complications include failure of the bone ends to unite or fusion of the broken ends at the wrong angle, infection of the bone, or damage to a nerve or artery.

A fracture of the lower shaft can cause permanent stiffness of the knee.... femur, fracture of

A prefix denoting a relationship to bone, as in osteoporosis, a condition in which the bones thin and weaken.... osteo-

Any generalized bone defect due to metabolic disorders.

Types of osteodystrophy include rickets; osteomalacia; osteoporosis due to Cushing’s syndrome or excessive intake of corticosteroid drugs; and bone cysts and bone mass reduction associated with chronic kidney failure or hyperparathyroidism.

In adults, an osteodystrophy is usually reversible if the underlying cause is treated before bone deformity occurs.... osteodystrophy

A break in a bone, usually across its width. There are 2 main types: closed (simple) or open (compound) fractures. In a closed fracture, the broken bone ends remain beneath the skin and little surrounding tissue is damaged; in an open fracture, 1 or both bone ends project through the skin. If the bone ends are not aligned, the fracture is termed “displaced”. Fractures can be further divided according to the pattern of the break, for example, transverse or spiral fractures of long bones. In a greenstick fracture, the break is not through the full width of the bone. This type of fracture occurs only in children because their bones are more pliable. In an avulsion fracture, a small piece of bone is pulled off by a tendon.Most fractures are the result of a fall, but in osteoporosis the bone is weakened, and fractures such as compression fractures of the vertebrae are common.

Common sites of fracture include the hand, wrist (see Colles’ fracture), ankle joint, clavicle, and the neck of the femur (see femur, fracture of). There is usually swelling and tenderness at the fracture site. The pain is often severe and is usually made worse by movement.

X-rays can confirm a fracture. Because bone begins to heal soon after it has broken, the first aim of treatment is to ensure that the bone ends are aligned. Displaced bone ends are manoeuvred

back into position, under general anaesthetic, by manipulation either through the skin or through an incision. The bone is then immobilized. In some cases the ends of the bone may be fixed with metal pins or plates.

Most fractures heal without any problems. Healing is sometimes delayed because the blood supply to the affected bone is inadequate (as a result of damaged blood vessels) or because the bone ends are not close enough together. If the fracture fails to unite, internal fixation or a bone graft may be needed. Osteomyelitis is a possible complication of open fractures. (See also Monteggia’s fracture; pelvis; Pott’s fracture; rib, fracture of; skull, fracture of.)... fracture

Removal of the stomach (total gastrectomy) or, more commonly, part of the stomach (partial gastrectomy). Total gastrectomy is used to treat some stomach cancers. Partial gastrectomy used to be a treatment for peptic ulcers but has largely been replaced by drug treatment.

Possible postoperative complications are fullness and discomfort after meals; regurgitation of bile, which may lead to gastritis, oesophagitis, and vomiting of bile; diarrhoea; and dumping syndrome. Other complications include malabsorption, which may lead to anaemia or osteoporosis. After total gastrectomy, patients cannot absorb vitamin B12 and are given it in the form of injections for the rest of their lives.... gastrectomy

Overproduction of parathyroid hormone by the parathyroid glands that raises the calcium level in the blood (hypercalcaemia) by removing calcium from bones. This may lead to bone disorders, such as osteoporosis. To try to normalize the high calcium level, the kidneys excrete large amounts of calcium in the urine, which can lead to the formation of kidney stones (see calculus, urinary tract).

Hyperparathyroidism is most often caused by a small noncancerous tumour of 1 or more of the parathyroid glands. It may also occur when the glands become enlarged for no known reason. It usually develops after age 40 and is twice as common in women as in men.

Hyperparathyroidism may cause depression and abdominal pain. However, often the only symptoms are those caused by kidney stones. If hypercalcaemia is severe, there may be nausea, tiredness, excessive urination, confusion, and muscle weakness.

The condition is diagnosed by X-rays of the hands and skull and by blood tests.

Surgical removal of abnormal parathyroid tissue usually cures the condition.

If the remaining tissue is unable to produce enough parathyroid hormone, treatment for hypoparathyroidism is required.... hyperparathyroidism

A drug used in the treatment of menopausal symptoms and to protect against osteoporosis.

The drug is given continuously and combines the effects of oestrogens and progestogens.

Possible adverse effects include irregular vaginal bleeding, changes in body weight, ankle oedema, dizziness, skin reactions, headache, migraine, growth of facial hair, depression, and myalgia.... tibolone

n. 1,25-dihydroxycholecalciferol: the final and most metabolically active form of vitamin D3. It is formed in the kidney by the addition of two hydroxy (?OH) groups to the basic vitamin D molecule, which itself is produced in the skin from 7-dehydrocholesterol or ingested in certain foods. Calcitriol is given to raise blood calcium levels in patients with severe kidney disease and to treat postmenopausal osteoporosis. It is also used as an ointment to treat psoriasis.... calcitriol

n. a *monoclonal antibody most commonly used in the treatment of postmenopausal osteoporosis to prevent fractures but also indicated at a higher dose to prevent bone damage in patients with bone metastases. Side-effects include a risk of low calcium, infections, joint pains, fatigue, and headache, all more common with the higher doses.... denosumab

(dual-energy X-ray absorptiometry) a method of measuring bone density based on the proportion of a beam of photons that passes through the bone. The results of a DEXA scan are expressed as a *T score. See also osteoporosis.... dexa

The generic term for the group of hormones produced by the ADRENAL GLANDS, with a profound e?ect on mineral and glucose metabolism.

Many modi?cations have been devised of the basic steroid molecule in an attempt to keep useful therapeutic effects and minimise unwanted side-effects. The main corticosteroid hormones currently available are CORTISONE, HYDROCORTISONE, PREDNISONE, PREDNISOLONE, methyl prednisolone, triamcinolone, dexamethasone, betamethasone, paramethasone and de?azacort.

They are used clinically in three quite distinct circumstances. First they constitute replacement therapy where a patient is unable to produce their own steroids – for example, in adrenocortical insu?ciency or hypopituitarism. In this situation the dose is physiological – namely, the equivalent of the normal adrenal output under similar circumstances – and is not associated with any side-effects. Secondly, steroids are used to depress activity of the adrenal cortex in conditions where this is abnormally high or where the adrenal cortex is producing abnormal hormones, as occurs in some hirsute women.

The third application for corticosteroids is in suppressing the manifestations of disease in a wide variety of in?ammatory and allergic conditions, and in reducing antibody production in a number of AUTOIMMUNE DISORDERS. The in?ammatory reaction is normally part of the body’s defence mechanism and is to be encouraged rather than inhibited. However, in the case of those diseases in which the body’s reaction is disproportionate to the o?ending agent, such that it causes unpleasant symptoms or frank illness, the steroid hormones can inhibit this undesirable response. Although the underlying condition is not cured as a result, it may resolve spontaneously. When corticosteroids are used for their anti-in?ammatory properties, the dose is pharmacological; that is, higher – often much higher – than the normal physiological requirement. Indeed, the necessary dose may exceed the normal maximum output of the healthy adrenal gland, which is about 250–300 mg cortisol per day. When doses of this order are used there are inevitable risks and side-effects: a drug-induced CUSHING’S SYNDROME will result.

Corticosteroid treatment of short duration, as in angioneurotic OEDEMA of the larynx or other allergic crises, may at the same time be life-saving and without signi?cant risk (see URTICARIA). Prolonged therapy of such connective-tissue disorders, such as POLYARTERITIS NODOSA with its attendant hazards, is generally accepted because there are no other agents of therapeutic value. Similarly the absence of alternative medical treatment for such conditions as autoimmune haemolytic ANAEMIA establishes steroid therapy as the treatment of choice which few would dispute. The use of steroids in such chronic conditions as RHEUMATOID ARTHRITIS, ASTHMA and DERMATITIS needs careful assessment and monitoring.

Although there is a risk of ill-effects, these should be set against the misery and danger of unrelieved chronic asthma or the incapacity, frustration and psychological trauma of rheumatoid arthritis. Patients should carry cards giving details of their dosage and possible complications.

The incidence and severity of side-effects are related to the dose and duration of treatment. Prolonged daily treatment with 15 mg of prednisolone, or more, will cause hypercortisonism; less than 10 mg prednisolone a day may be tolerated by most patients inde?nitely. Inhaled steroids rarely produce any ill-e?ect apart from a propensity to oral thrush (CANDIDA infection) unless given in excessive doses.

General side-effects may include weight gain, fat distribution of the cushingoid type, ACNE and HIRSUTISM, AMENORRHOEA, striae and increased bruising tendency. The more serious complications which can occur during long-term treatment include HYPERTENSION, oedema, DIABETES MELLITUS, psychosis, infection, DYSPEPSIA and peptic ulceration, gastrointestinal haemorrhage, adrenal suppression, osteoporosis (see BONE, DISORDERS OF), myopathy (see MUSCLES, DISORDERS OF), sodium retention and potassium depletion.... corticosteroids

Described in 1932 by Harvey Cushing, the American neurosurgeon, Cushing’s syndrome is due to an excess production of CORTISOL. It can thus result from a tumour of the ADRENAL GLANDS secreting cortisol, or from a PITUITARY GLAND tumour secreting ACTH and stimulating both adrenal cortexes to hypertrophy and secrete excess cortisol. It is sometimes the result of ectopic production of ACTH from non-endocrine tumours in the LUNGS and PANCREAS.

The patient gains weight and the obesity tends to have a characteristic distribution over the face, neck, and shoulder and pelvic girdles. Purple striae develop over the abdomen and there is often increased hairiness or hirsutism. The blood pressure is commonly raised and the bone softens as a result of osteoporosis. The best test to establish the diagnosis is to measure the amount of cortisol in a 24-hourly specimen of urine. Once the diagnosis has been established, it is then necessary to undertake further tests to determine the cause.... cushing’s syndrome

Drugs used to slow bone metabolism (for example in Paget’s disease) and to reduce the high calcium levels in the blood associated with destruction of bone by secondary cancer growths.

Bisphosphonates are also used in the prevention or treatment of osteoporosis.... bisphosphonate drugs

The compactness of bone tissue in relation to its volume. A decrease in bone density is a normal part of aging. However, in some people, excessive loss of density (see osteoporosis) can lead to fractures. Less commonly, an increase in bone density (see osteosclerosis) occurs in certain disorders (see osteopetrosis; Paget’s disease). Bone density can be measured by a technique known as densitometry, which uses low-dose X-rays.... bone density

Bones with an increased tendency to fracture. They are a feature of osteoporosis and may occur in people who are taking corticosteroid drugs, are immobile, or have certain hormonal disorders. In osteomalacia, the bones are soft and have an increased tendency both to become deformed and to fracture. The inherited disorder osteogenesis imperfecta is a rare cause of brittle bones and frequent fractures and is usually detected in infancy.... brittle bones

If you haven’t heard much about oat straw tea, it’s time to find out! It has a delicious, slightly sweet taste, as well as many benefits which will help you stay healthy. Read this article to find out more about this tea! About Oat Straw Tea Oat straw tea is made from oat straw, which is the part of the oat plant, found above the ground, and which remains after the grain has been harvested. While at first it was used only to stuff mattresses, now it is much more appreciated thanks to its health benefits, which you can get by drinking oat straw tea, as well. Oat is cultivated in temperate areas on almost all continents, even in a few places in Africa. It is used, for example, to make oat flour, oat bread; in Britain, it is also used to brew beer. It can also be fed to horses or cattle. Constituents of Oat Straw Tea Oat is considered an important “health food” and quite a nutritious one too. Oat straw has important, benefic constituents which are also included in oat straw tea. The main constituents, also found in oat straw tea, are carbohydrates and silicic acid. It is also rich in calcium, potassium, and magnesium, and has a reasonable amount of proteins. As for vitamins, it includes A, B complex, C and E. How to prepare Oat Straw Tea A classic way to prepare a cup of oat straw tea is to add a teaspoon of dried oat straw to a cup of boiling water. Let it steep for about 10 minutes before you strain to remove the oat straw plant. You can add milk or honey to sweeten the taste. If you can and want to prepare oat straw tea from scratch, you can do that too. Pick up the necessary amount (or even more, which you can keep for later uses), wash and cut off any dirty parts. For two cups of oat straw tea, you can use a single stalk, which you cut into small pieces and add in each cup. Then, pour the boiling water and let it steep for 4 hours, or even overnight. When it’s done, strain it and drink it, either cold or reheated. The same steps apply if you want to use dry oat straws for a few cups of oat straw tea. Oat Straw Tea Benefits Oat straw tea is especially good for strengthening and nourishing your bones, thanks to the amount of calcium it contains. This way, it helps you fight against osteoporosis. It is good to drink oat straw tea in order to stabilize the sugar in your blood, as it reduces cholesterol levels and improve blood circulation. Oat straw tea is also good at improving your immune system, and it is good at alleviating pains. Drinking it can reduce headaches and menstrual cramps. Drinking oat straw tea can also help you relax your nervous system. It has a calming effect, and helps you fight against stress, tension, anxiety and even depression. Also, a cup of oat straw tea before bed will help you sleep better. You don’t need to consider oat straw tea only as a beverage in order to make use of its health benefits. It can also be applied externally, on the skin, in order to treat skin irritations, such as eczema or rashes. Also, a bath in oat straw tea is helpful for children with chicken pox. Oat straw Side Effects First of all, it is recommended that you not drink more than three cups of oat straw tea a day. If you do, it might become harmful. Some of the symptoms you might experience are headaches, dizziness, insomnia, irregular heartbeats, vomiting, diarrhea and loss of appetite. Make sure you reduce the amount of oat straw tea you drink if you get any of these symptoms. If you’re allergic to oat flour, you should also stay away from oat straw tea. It might lead to an allergic reaction. In this case, the symptoms you might get are difficulty in breathing, rashes, itching, or swelling of the throat or mouth. Also, if you’re suffering from celiac diseases, you should avoid drinking oat straw tea.Oat straw contains gluten, which can be harmful in this case. Oat straw tea has plenty of health benefits which should convince you to give it a try and maybe even include it in your daily diet. It can be easily prepared from scratch, and also sweetened to fit with your taste. Just be careful with its side effects, and enjoy your cup of oat straw tea!... drink more oat straw tea!

An imaging technique that uses low-dose X-rays to measure bone density, as determined by the concentration of calcified material. It is used to diagnose and assess the severity of osteoporosis, especially in the spine and femur, and to assess its response to treatment. During the procedure, X-rays are passed through the body. A computer assesses the amount of X-rays absorbed by the body and uses this information to calculate the bone density.... densitometry

Dual-energy X-ray absorptiometry, a technique that measures bone density by passing beams of lowdose radiation through bone. scans are used to assess the severity of osteoporosis. (See also densitometry.)... dexa scan

curvature of the spine in the cervical (neck) and upper thoracic region (kyphosis), caused by compression fractures from osteoporosis. These fractures may be asymptomatic but when symptomatic cause significant pain. Long-term lung function may be compromised by the abnormal curvature of the spine. Compare buffalo hump.... dowager’s hump

n. a condition in which bone mineral density is lower than normal, but less severe than *osteoporosis (see T score). It may be generalized or localized, due to inflammation.... osteopenia

(parathormone) a hormone, synthesized and released by the parathyroid glands, that controls the distribution of calcium and phosphate in the body. A high level of the hormone causes transfer of calcium from the bones to the blood; a deficiency lowers blood calcium levels, causing *tetany. This condition may be treated by injections of calcium gluconate. Compare calcitonin.

Recombinant parathyroid hormone (Preotact) is given by subcutaneous injection to treat postmenopausal osteoporosis.... parathyroid hormone

Safflower tea has a strong, but pleasant taste. As an herbal tea, it comes with many health benefits which are bound to help you stay healthy. Find out more about safflower tea! About Safflower Tea Safflower tea is made from the petals of safflower. The plant is an herbaceous, annual herb, which is cultivated in over sixty countries worldwide. It is a highly branched plant, with heights between 30cm and 150cm. Each branch has from one to five globular flower heads, with yellow, orange, or red flowers. The flower heads also contain 15-20 small seeds. The plant grows in open, arid environments; it is harvested during summertime. The plant was initially cultivated for its seeds, which are used to flavor and color food, as well as to make red and yellow dyes. Lately, the seeds are also used to make vegetable oil. How to prepare Safflower Tea You can easily prepare a cup of safflower tea. Just add a teaspoon of dried safflower petals to a cup of freshly boiled water. Let it steep for about 5 minutes, before you strain it to remove the petals. Your cup of safflower tea is ready! If the taste isn’t to your liking, you can sweeten the tea with honey or fruit juice. Safflower Tea Benefits A cup of safflower tea can help soothe your nerves, as well as relax you. Also, it can treat fevers, coughs and bronchial spasms. Generally, it is good at strengthening your immunity. Drinking safflower tea will also lower your bad cholesterol levels; this leads to preventing various heart diseases. It helps in the case of intestinal disorders, and it also facilitates bowel movement. Safflower tea can improve the conditions of cancer patients. This is why it is often included in the treatment for various types of cancer. Also, it can prevent osteoporosis, especially in the case of postmenopausal women. Safflower tea can be applied topically, as well. It is used to treat various bruises, open wounds, or rashes, as well as other skin disorders. Safflower Tea Side Effects Safflower tea doesn’t have many side effects. An important one is related to pregnant and breastfeeding women, who shouldn’t consume this tea. During pregnancy, it can even lead to miscarriages. It’s best not to drink thistea if you have bleeding problems. Safflower tea can slow down the blood clotting process, which might affect you if you’ve got hemorrhagic diseases, stomach or intestinal ulcers, or clotting disorders. Also, stop drinking it two weeks before a surgery, as it might cause bleeding during and after the surgery. Some people might be allergic to plants from the Asteraceae or Compositae family. Beside safflower, these include ragweed, chrysanthemums, marigolds, and daisies. Symptoms of an allergic reaction include swelling of the nose, lips and tongue, rashes and difficulty in breathing. If you get any of these, stop drinking safflower tea and contact your doctor.   Safflower tea is a good choice for an everyday tea. With this herbal tea, you get to enjoy both its taste and its many health benefits.... drink more safflower tea!

Previously called juvenile rheumatoid arthritis and juvenile chronic arthritis, this is a set of related conditions of unknown cause affecting children. Characteristically, the synovial membrane of a joint or joints becomes in?amed and swollen for at leat six weeks (and often very much longer – even years). About 1 in 10,000 children develop it each year, many of whom have certain HLA genetic markers, thought to be important in determining who gets the illness. In?ammatory CYTOKINES play a big part.

Clinical features There are various types. The oligoarthritic type involves 1–4 joints (usually knee or ankle) which become hot, swollen and painful. One complication is an in?ammation of the eyes – UVEITIS. The condition often ‘burns out’, but may reappear at any time, even years later.

The polyarthritic type is more like RHEUMATOID ARTHRITIS in adults, and the child may have persistent symptoms leading to major joint deformity and crippling.

The systemic type, previously called Still’s disease, presents with a high fever and rash, enlarged liver, spleen and lymph nodes, and arthritis – although the latter may be mild. In some children the illness becomes recurrent; in others it dies down only to return as polyarthritis.

Complications These include uveitis, which can lead to loss of vision; a failure to thrive; osteoporosis (see under BONE, DISORDERS OF); joint deformity; and psychosocial diffculties.

Treatment This includes ANTIPYRETICS and ANALGESICS, including NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS), intra-articular steroid injections, anti-tumour necrosis factor drugs and steroids.

Physiotherapy is vital, and children may need to wear splints or other orthotic devices to alleviate deformity and pain. Orthopaedic operative procedures may be necessary.... juvenile idiopathic arthritis (jia)

a fracture through diseased or abnormal bone, usually resulting from a force insufficient to fracture a normal bone. Tumour, infection, congenital bone defects, and osteoporosis are among the causes.... pathological fracture

receptor activator of nuclear factor kappa B ligand inhibitor: an agent that works by inhibiting the development of *osteoclasts and bone resorption, thus minimizing bone loss and the potential for fractures in those with postmenopausal osteoporosis and bone metastases.... rankl inhibitor

a measure of bone mineral density used to evaluate the degree of bone thinning detected on *DEXA scanning. An individual’s T score is the number of standard deviations above or below the mean reference value for young healthy adults. By convention, a score above –1 is considered normal, a score between –1 and –2.5 indicates osteopenia, and a score below –2.5 indicates *osteoporosis.... t score

The term ‘eating disorders’ covers OBESITY, feeding problems in childhood, anorexia nervosa, and bulimia nervosa. The latter two are described here.

Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.

Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).

The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.

There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.

Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.

If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.

About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.

Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.

Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.

Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.

Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders

A collection of disorders in which some part of the body’s internal chemistry (see METABOLISM; CATABOLISM) is disrupted. Some of these disorders arise from inherited de?ciencies in which a speci?c ENZYME is absent or abnormal, or does not function properly. Other metabolic disorders occur because of malfunctions in the endocrine system (see ENDOCRINE GLANDS). There may be over- or underproduction of a hormone involved in the control of metabolic activities: a prime example is DIABETES MELLITUS – a disorder of sugar metabolism; others include CUSHING’S SYNDROME; hypothyroidism and hyperthyroidism (see THYROID GLAND, DISEASES OF); and insulinoma (an insulin-producing tumour of the pancreas). The bones can be affected by metabolic disorders such as osteoporosis, osteomalacia (rickets) and Paget’s disease (see under BONE, DISORDERS OF). PORPHYRIAS, HYPERLIPIDAEMIA, HYPERCALCAEMIA and gout are other examples of disordered metabolism.

There are also more than 200 identi?ed disorders described as inborn errors of metabolism. Some cause few problems; others are serious threats to an individual’s life. Individual disorders are, fortunately, rare – probably one child in 10,000 or 100,000; overall these inborn errors affect around one child in 1,000. Examples include GALACTOSAEMIA, PHENYLKETONURIA, porphyrias, TAY SACHS DISEASE and varieties of mucopolysaccharidosis, HOMOCYSTINURIA and hereditary fructose (a type of sugar) intolerance.... metabolic disorders

Diseases developing during a person’s lifetime may be the result of his or her lifestyle, environment, genetic factors and natural AGEING factors.

Lifestyle While this may change as people grow older – for instance, physical activity is commonly reduced – some lifestyle factors are unchanged: for example, cigarette smoking, commonly started in adolescence, may be continued as an adult, resulting in smoker’s cough and eventually chronic BRONCHITIS and EMPHYSEMA; widespread ATHEROSCLEROSIS causing heart attacks and STROKE; osteoporosis (see BONE, DISORDERS OF) producing bony fractures; and cancer affecting the lungs and bladder.

Genetic factors can cause sickle cell disease (see ANAEMIA), HUNTINGTON’S CHOREA and polycystic disease of the kidney.

Ageing process This is associated with the MENOPAUSE in women and, in both sexes, with a reduction in the body’s tissue elasticity and often a deterioration in mental and physical capabilities. When compared with illnesses described in much younger people, similar illnesses in old age present in an atypical manner

– for example, confusion and changed behaviour due to otherwise asymptomatic heart failure, causing a reduced supply of oxygen to the brain. Social adversity in old age may result from the combined effects of reduced body reserve, atypical presentation of illness, multiple disorders and POLYPHARMACY.

Age-related change in the presentation of illnesses This was ?rst recognised by the specialty of geriatric medicine (also called the medicine of ageing) which is concerned with the medical and social management of advanced age. The aim is to assess, treat and rehabilitate such patients. The number of institutional beds has been steadily cut, while availability of day-treatment centres and respite facilities has been boosted – although still inadequate to cope with the growing number of people over 65.

These developments, along with day social centres, provide relatives and carers with a break from the often demanding task of looking after the frail or ill elderly. As the proportion of elderly people in the population rises, along with the cost of hospital inpatient care, close cooperation between hospitals, COMMUNITY CARE services and primary care trusts (see under GENERAL PRACTITIONER (GP)) becomes increasingly important if senior citizens are not to suffer from the consequences of the tight operating budgets of the various medical and social agencies with responsibilities for the care of the elderly. Private or voluntary nursing and residential homes have expanded in the past 15 years and now care for many elderly people who previously would have been occupying NHS facilities. This trend has been accelerated by a tightening of the bene?t rules for funding such care. Local authorities are now responsible for assessing the needs of elderly people in the community and deciding whether they are eligible for ?nancial support (in full or in part) for nursing-home care.

With a substantial proportion of hospital inpatients in the United Kingdom being over 60, it is sometimes argued that all health professionals should be skilled in the care of the elderly; thus the need for doctors and nurses trained in the specialty of geriatrics is diminishing. Even so, as more people are reaching their 80s, there seems to be a reasonable case for training sta? in the type of care these individuals need and to facilitate research into illness at this stage of life.... medicine of ageing

A MALIGNANT disorder of PLASMA cells, derived from B-lymphocytes (see LYMPHOCYTE). In most patients the BONE MARROW is heavily in?ltrated with atypical, monoclonal plasma cells, which gradually replace the normal cell lines, inducing ANAEMIA, LEUCOPENIA, and THROMBOCYTOPENIA. Bone absorption occurs, producing di?use osteoporosis (see under BONE, DISORDERS OF). In some cases only part of the immunoglobulin molecule is produced by the tumour cells, appearing in the urine as Bence Jones PROTEINURIA.

The disease is rare under the age of 30, frequency increasing with age to peak between 60 and 70 years. There may be a long preclinical phase, sometimes as long as 25 years. When symptoms do occur, they tend to re?ect bone involvement, reduced immune function, renal failure, anaemia or hyperviscosity of the blood. Vertebral collapse is common, with nerve root pressure and reduced stature. The disease is eventually fatal, infection being a common cause of death. Local skeletal problems should be treated with RADIOTHERAPY, and the general disease with CHEMOTHERAPY

– chie?y the ALKYLATING AGENTS melphalan or cyclophosphamide. Red-blood-cell TRANSFUSION is usually required, together with plasmapheresis (see PLASMA EXCHANGE), and orthopaedic surgery may be necessary following fractures.... myelomatosis

One of the ANABOLIC STEROIDS, with the property of building PROTEIN. It is of little value in medical care, although is licensed for use in aplastic ANAEMIA; it has also been used in the past to treat osteoporosis in women (see under BONE, DISORDERS OF), but is no longer recommended for this purpose. Its use as a bodybuilder by some athletes and others has caused controversy: those found using it are barred from most recognised athletic events. Nandrolone should never be taken by pregnant women or by people with liver disease or prostate cancer. Side-effects include ACNE; VIRILISATION with high doses including voice changes, cessation of periods, and inhibition of sperm production; and liver tumours after prolonged use.... nandrolone

Nepal Tea is a type of black teathat gets its name from the South-Asian country of origin. It is a bright yellow tea which has a delicate floral aroma and combines the ripe fruit sweetness with a tinge of bitterness. This fruity tea is hand-processed and considered one of the best teas in the world, similar in flavour to the more famous Darjeeling Tea. Nepal Tea brewing The first rule of tea-making is the use of fresh water which maintains the flavour intact. Nepal black tea brewingshould last two or three minutes, up to five minutes for a stronger taste, but take care not to over-brew it, because both the aroma and the taste will be spoiled. You can prolong the brewing time only if you want to add milk or sugar to your cup of tea. When to drink Nepal Tea You can sip Nepal Tea at any point during the day because it is a fruity refined beverage, ideal for experiencing an energy surplus. Nepal Tea Health Benefits Nepal Tea consumption can bring numerous health benefits for individuals. People who drink black tea are generally healthier; they have a considerably lower rate of heart attacks or strokes, as well as lower risks of ever suffering from certain types of cancer, such as colon and lung cancer. Research shows that drinking black tea also decreases the risk of osteoporosis and diabetes and improves teeth health. Nepal Tea Side Effects Like other types of black tea, Nepal black Tea contains caffeine which increases mental alertness, but may also lead to insomnia and anxiety. When consumed in large quantities, it may cause unpleasant digestive side effects such as upset stomach symptoms. In a busy and crowded world, almost everyone could use a little bit of help to boost up their energy and at the same time, increase their mental alertness. Apart from having an enchanting aroma, Nepal Tea brings tremendous benefits by relieving stress and keeping tea drinkers stay alert at the same time.... nepal tea

Oolong tea, literally meaning “Black Dragon”, is a traditional Chinese beverage which undergoes a unique preparation process resulting in a reddish drink with a slightly sweet delicate flavour. Oolong tea is partially fermented, unlike black tea, which is fully fermented, or green tea, which is unfermented. Oolong Tea Brewing Oolong tea requires a higher brewingtemperature in order to extract the complex aromas of the tea leaves. It is recommended to use spring or filtered water heated at a temperature of approximately 90 degrees Celsius. The steeping process for most Oolong teas should last no longer than five minutes. If this period is extended for too long, it may ruin the delicate aromas and turn your cup of tea unpleasantly bitter. Oolong teas are best served plain, but you can add milk, sugar, honey or lemon according to your taste. Oolong Tea Health Benefits Oolong tea, a hybrid between black and green tea, has numerous health benefits, especially if consumed regularly. Drinking Oolong tea stimulates brain activity and relieves mental and physical stress. Oolong tea has the potential of reducing high blood pressure, lowering blood sugar levels and preventing serious afflictions like obesity, osteoporosis, tooth decay, cancer or heart disease. Oolong tea accelerates the metabolism and promotes weight loss. Another health benefit of Oolong tea is its effectiveness in treating skin problems such as eczema and rashes and combating skin aging. Oolong Tea Side Effects Although drinking Oolong tea is extremely beneficial for the body, it can also lead to unpleasant side effects when consumed in large quantities, therefore moderation is required. These side effects include sleeping difficulties, anxiety or irritability, most of them related to excessive caffeine intake. It is not recommended for pregnant women and people suffering from kidney disorders. Furthermore, oolong tea has been proven to interact with certain medications; therefore, people who undertake treatment are advised to consult a health care provider first. Oolong tea is extremely effective in keeping your energy levels up, due to its caffeine content, and it also increases brain function, helping you maintain active and aware throughout the day.... oolong tea health benefits, side effects and brewing

Pu’erh tea is a type of post-fermented tea produced in China. Read this article to find out more about its many health benefits! About Pu’erh Tea Pu’erh tea is a post-fermented tea produced in the Chinese province Yunnan. Post-fermented teas are different from other types of tea in the sense that, after the leaves are dried and rolled, they undergo a microbial fermentation process. The pu’erh teais available as loose leaves or as tea brick (tea leaves packed in molds and pressed into block form). There are also two categories of pu’erh tea: the raw type and the ripe type. Raw pu’erh tea can count as a type of green tea. Ripened or aged pu’erh tea is often mistakenly called a type of black tea, though it isn’t. How to prepare Pu’erh Tea Pu’erh tea can be bought and prepared in loose leaf form, in tea bag form, or in compacted cake form. If you’re using leaves, add a teaspoon to a cup of freshly boiled water and let it steep for about 20 seconds before you pour off the water; this process id called rinsing, in order to prepare the leaves for the tea. Next, pour freshly boiled water again, let it steep for 30 seconds or one minute. This will give the tea a mild, but pleasant flavor. If you want a stronger flavor, you can let it steep up to 50 minutes, until it turns as dark as coffee. Pu’erh leaves can be resteeped several times (4-8 times). Just add about 20 more seconds to each steeping process. The same applies to pu’erh tea in compacted cake form. To get the leaves, either flake off pieces of the cake, or steam the entire cake until it becomes soft. Pu’erh Tea Benefits Pu’erh tea had important health benefits related to blood circulation. It can help lower blood cholesterol levels. It also boosts the flow of blood and enhances your blood circulation. Drinking pu’erh tea can help prevent cancer, as it helps prevent the formation and growth of cancer cells. It also promotes a proper, healthy digestion, and is good for your spleen. You don’t have to worry even if you’re on a diet; drinking pu’erh tea will help you lose weight, as it breaks down and reduces the fat in your body. As pu’erh tea contains caffeine, drinking it helps keep you alert and focused. It also helps with removing toxins from your body, and it can prove to be useful if you’re dealing with various aches and pains. Pu’erh tea can also help you if you’ve got a hangover, especially if you get a headache. Also, it can act as a substitute for coffee, and can have a relaxing effect on you. Pu’erh Tea Side Effects Because of its caffeine content, pu’erh tea shouldn’t be consumed by pregnant or breastfeeding women, as it can affect the baby. Also, you shouldn’t drink pu’erh tea if you’ve got anxiety, bleeding disorders, heart problems, diabetes, irritable bowel syndrome, glaucoma, high blood pressure or osteoporosis. It can affect your condition in all of these cases. Pu’erh tea can also interact with medications. A few examples include amphetamines, cimetidine, ephedrine, adenosine, or medications for depression, asthma and slow blood clotting. The list includes more, so if you’re under medication, make sure you check with your doctor first, to see if it’s safe to drink pu’erh tea.   Pu’erh tea has important health benefits, though the same goes for side effects, as well. Make sure it’s safe to drink pu’erh tea, and then you can enjoy a cup of tea without having to worry about its side effects.... pu’erh tea pros and cons

Linn.

Family: Umbelliferae; Apiaceae.

Habitat: East Bengal, Bhutan and Assam.

Folk: Muraa (var.).

Action: Fruits—extracts used for osteoporosis, gynaecological problems and stress-related disorders. Seeds—prescribed in rheumatism and renal diseases.

In Japan, the plant is mainly used for the treatment of swelling of women's genitals.

The aerial parts contain the chromo- nes, cnidimol and karenin. The fruits contain the benzofurans, cnidioside A, B and C, cnidiol b and C; besides fura- nocoumarins, imperatorin, bergapten, xanthotoxin, osthol and several ter- penoids. The seeds and volatile oil from the fruits also contain osthol and other coumarins.

The coumarins prevented glucocor- ticoid-induced osteoporosis in rats; they also reversed bone loss at early menopausal stage. Osthol showed antiallergic activity. Cnidioside A and B and cnidiol b alleviate physiological disorders caused by physical and mental stress; enhancement of sexual activity has also been observed.... selinum monnieri

Scoliosis A condition where the spine is curved to one side (the spine is normally straight when seen from behind). The deformity may be mobile and reversible, or ?xed; if ?xed it is accompanied by vertebral rotation and does not disappear with changes in posture. Fixed scoliosis is idiopathic (of unknown cause) in 65–80 per cent of cases. There are three main types: the infantile type occurs in boys under three and in 90 per cent of cases resolves spontaneously; the juvenile type affects 4–9 year olds and tends to be progressive. The most common type is adolescent idiopathic scoliosis; girls are affected in 90 per cent of cases and the incidence is 4 per cent. Treatment may be conservative with a ?xed brace, or surgical fusion may be needed if the curve is greater than 45 degrees. Scoliosis can occur as a congenital condition and in neuromuscular diseases where there is muscle imbalance, such as in FRIEDREICH’S ATAXIA.

Kyphosis is a backward curvature of the spine causing a hump back. It may be postural and reversible in obese people and tall adolescent girls who stoop, but it may also be ?xed. Scheuermann’s disease is the term applied to adolescent kyphosis. It is more common in girls. Senile kyphosis occurs in elderly people who probably have osteoporosis (bone weakening) and vertebral collapse.

Disc degeneration is a normal consequence of AGEING. The disc loses its resiliance and becomes unable to withstand pressure. Rupture (prolapse) of the disc may occur with physical stress. The disc between the fourth and ?fth lumbar vertebrae is most commonly involved. The jelly-like central nucleus pulposus is usually pushed out backwards, forcing the annulus ?brosus to put pressure on the nerves as they leave the spinal canal. (See PROLAPSED INTERVERTEBRAL DISC.)

Ankylosing spondylitis is an arthritic disorder of the spine in young adults, mostly men. It is a familial condition which starts with lumbar pain and sti?ness which progresses to involve the whole spine. The discs and ligaments are replaced by ?brous tissue, making the spine rigid. Treatment is physiotherapy and anti-in?ammatory drugs to try to keep the spine supple for as long as possible.

A National Association for Ankylosing Spondylitis has been formed which is open to those with the disease, their families, friends and doctors.

Spondylosis is a term which covers disc degeneration and joint degeneration in the back. OSTEOARTHRITIS is usually implicated. Pain is commonly felt in the neck and lumbar regions and in these areas the joints may become unstable. This may put pressure on the nerves leaving the spinal canal, and in the lumbar region, pain is generally felt in the distribution of the sciatic nerve – down the back of the leg. In the neck the pain may be felt down the arm. Treatment is physiotherapy; often a neck collar or lumbar support helps. Rarely surgery is needed to remove the pressure from the nerves.

Spondylolisthesis means that the spine is shifted forward. This is nearly always in the lower lumbar region and may be familial, or due to degeneration in the joints. Pressure may be put on the cauda equina. The usual complaint is of pain after exercise. Treatment is bed rest in a bad attack with surgery indicated only if there are worrying signs of cord compression.

Spinal stenosis is due to a narrowing of the spinal canal which means that the nerves become squashed together. This causes numbness with pins and needles (paraesthia) in the legs. COMPUTED TOMOGRAPHY and nuclear magnetic resonance imaging scans can show the amount of cord compression. If improving posture does not help, surgical decompression may be needed.

Whiplash injuries occur to the neck, usually as the result of a car accident when the head and neck are thrown backwards and then forwards rapidly. This causes pain and sti?ness in the neck; the arm and shoulder may feel numb. Often a support collar relieves the pain but recovery commonly takes between 18 months to three years.

Transection of the cord occurs usually as a result of trauma when the vertebral column protecting the spinal cord is fractured and becomes unstable. The cord may be concussed or it may have become sheared by the trauma and not recover (transected). Spinal concussion usually recovers after 12 hours. If the cord is transected the patient remains paralysed. (See PARALYSIS.)... spine and spinal cord, diseases and injuries of

Stem CELLS develop a few days after an egg (ovum) is fertilised by a spermatozoon and starts developing to form an EMBRYO. These master cells are crucial to the development of a normal embryo. They contain a specialised ENZYME that gives them the facility to divide inde?nitely, developing into the many di?erent specialised cells that comprise the various tissues in the body – for example, skin, blood, muscle, glands or nerves.

In a highly signi?cant advance in research, a scienti?c team in the United States obtained stem cells from newly formed human embryos

– donated by women who had become pregnant after successful in vitro fertilisation – and successfully cultivated these cells in the laboratory. This achievement opened the way to replicating in the laboratory, the various specialised cells that develop naturally in the body. UK government legislation constrains the use of human embryos in research (see ETHICS) and the ethical aspects of taking this stem-cell culture technique forwards will have to be resolved. Nevertheless, this discovery points the biological way to the use of genetic engineering in selecting di?erentiated specialised cells from which replacement tissues could be grown for use as transplants to rectify absent or damaged tissues in the human body.

Research into potential use of stem cells has raised expectations that in the long term they may prove to be an e?ective regenerative treatment for a wide range of disorders including PARKINSONISM, ALZHEIMER’S DISEASE, type-2 diabetes (see under DIABETES MELLITUS), myocardial infarction (see HEART, DISEASES OF), severe burns, osteoporosis (see under BONE, DISORDERS OF) and the regeneration of blood to replace the need for BONE MARROW TRANSPLANT. Recent research has shown that adult stem cells may also be stimulated to produce new cell lines. If successful, this would eliminate the need to use embryos and thus resolve existing ethical dilemmas over the use of stem cells.... stem cell

Abortion is a medical procedure of ending a pregnancy during its first 24 weeks. There are several reasons why this medical process is carried out: a fetus’ or woman’s health issue or, most frequent, there are personal considerations which impede the woman to keep the baby. No matter the reasons of an abortion, it should be made by a physician. Also, the woman’s post-abortion state requires medical observation, because there have been acknowledged physical and psychological effects after this medical condition. Like any other medical procedure, abortion implies risks, like losing a large amount of blood (haemorrhage) or inflammation of the pelvis. Studies revealed that further miscarriages can be associated with earlier abortions, as the surgery may lead to the damage of the womb. A pregnancy can be ended by a medical procedure or, by a traditional method, like drinking teas causing abortion. How Tea for Abortion works There are two categories of tea which lead to ending a pregnancy: emmenagogue and abortifacient teas. The first type of tea induces woman’s period to start, whereas the second one causes painful contractions of the uterus, followed by abortion. Teas leading to Abortion Please read the list of some of the teas you should not drink if you are pregnant or, you try to become pregnant. Blue Cohosh is a wood plant, growing in New England (United States) and also in Canada. It has anti-inflammatory and antispasmodic properties. It is generally used to treat rheumatism and to prevent osteoporosis. Muscles aches caused by physical effort are relieved by taking Blue Cohosh as tea, tincture or decoction. It cannot stimulate the estrogen production thus, the body is not able to provide the endometrial and uterine growth, leading to contractions of the uterine and, finally, to a painful abortion. Unfortunately, Blue Cohosh tea has been used for a long period of time as a medicinal and home-made beverage for abortion. Pennyroyal is a plant from the mint family, whose essential oil is toxic if taken internally. In the past, women were poisoning themselves in the attempt of ending the pregnancy. Taken as an infusion, the plant is efficient in mitigating the unpleasant feelings of the upset stomach, abdominal cramps , as well as colds. Pennyroyal tea should not be drunk by pregnant women or by those who want to become pregnant, because it irritates the uterus, causing contractions and, of course, abortion. Tansy is a herbaceous plant, originating from Europe, but also cultivated in the United States. It is best known for its action as an insect repellant, being used as treatment against worms. It is a digestion adjuvant as well as a migraine reliever. Tansy tea provides contractions of the uterus and abortion, which can be so violent that causes death, just like the above mentioned teas causing abortion. Uterine bleeding, nausea and loss of consciousness are some of the signs displayed by people who had ingested a large dose of the beverage. Women should bear in mind that these three types of tea are scientifically proven to cause abortion. So, they should not consume them! Furthermore, women should ask their doctor for a list of the edible products while pregnancy, in order to avoid unpleasant situations of any kind.  ... teas causing abortion

This occurs in one in 2,500 live female births. It is caused by either the absence of or an abnormality in one of the two X CHROMOSOMES. Classical Turner’s syndrome is a complete deletion of one X so that the karyotype is 45XO. Half of the people with Turner’s syndrome have MOSAICISM with a mixture of Turner cells and normal cells, or other abnormalities of the X chromosome such as partial deletions or a ring X. They are females, both in appearance and sexually; clinical features are variable and include short stature, with ?nal height between 1·295 m and 1·575 m, and ovarian failure. Other clinical features may include a short neck, webbing of the neck, increased carrying angle at the elbow (cubitus valgus), widely spaced nipples, cardiovascular abnormalities (of which the commonest is coarctation of the aorta [about 10 per cent]), morphological abnormalities of the kidneys (including horseshoe kidney and abnormalities of the pelviureteric tracts), recurrent otitis media (see under EAR, DISEASES OF), squints, increased incidence of pigmented naevi (see NAEVUS), hypothyroidism (see under THYROID, DISEASES OF) and DIABETES MELLITUS. Intelligence is across the normal range, although there are speci?c learning defects which are related to hand-eye coordination and spatial awareness.

Patients with Turner’s syndrome may require therapeutic help throughout their life. In early childhood this may revolve around surgical correction of cardiovascular disease and treatment to improve growth. Usually, PUBERTY will need to be induced with oestrogen therapy (see OESTROGENS). In adult life, problems of oestrogen therapy, prevention of osteoporosis (see under BONE, DISORDERS OF), assessment and treatment of HYPERTENSION and assisted fertility predominate. For the address of the UK Turner Syndrome Society, see Appendix 2.... turner’s syndrome

White tea is a fruity low-caffeine beverage with a delicate aroma and a sweet or bittersweet taste. Despite its name, it has a pale yellow colour. White tea originated in the Fujian province of China sometime in the 18th century. Green tea and black tea are made from the leaves of the tea plant, whereas white tea is prepared from its white fuzzy buds. White tea is minimally processed, withered in natural sunlight and only slightly oxidized. White Tea Brewing White tea brewing is a quite easy procedure. When preparing white tea, preferably use water heated at a below boiling temperature of approximately 80 degrees Celsius and steep it for three to five minutes. White tea should be enjoyed plain because milk might neutralize its beneficial properties. White Tea Health Benefits White tea consumption offers your body numerous health benefits by boosting the immune system and strengthening its power to fight against viruses and bacteria. The beverage is also effective in the prevention of dental plaque, one of the main causes of tooth decay, and it may also have a beneficial effect for people afflicted with osteoporosis or arthritis. Research shows that some white tea compounds protect against cancer, reduce the cholesterol level and improve artery function, thus lowering the risk of cardiovascular disease. The antioxidants in white tea protect the skin and make it appear healthy and radiant. Regular consumption of white tea may also prevent obesity and aid in the weight-loss process. White tea increases metabolism, encouraging the burning of fat. White Tea Side Effects Although white tea has low caffeine content, some people may still experience unpleasant side effects which include anxiety, sleeping difficulties, nausea, faster heart rate, tremors or gastrointestinal problems. Enjoy the pleasant aroma ofwhite tea and its health benefits at any time of the day. You have a wide range of white teas you can choose from and you can drink as many as four cups a day. White tea is definitely one of nature’s great gifts!... white tea - health benefits, information

Three to four daily drinks for several weeks result in increased fat in liver cells. Then comes alcoholic hepatitis, inflammation of the liver tissue and destruction of cells, degenerating into an irreversible state known as cirrhosis. Complications develop such as intestinal bleeding, fluid accumulation, kidney failure and death if not arrested in time. Alcoholism is compulsive drinking leading to dependence.

Alternatives: Teas. Hops, Angelica, German Chamomile, or Skullcap. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup 3-4 times daily.

Tablets/capsules. Cramp bark, Black Cohosh, Valerian.

Formula. Equal parts: Cramp bark and Valerian. Dose – powders: 250mg, or one 00 capsule; liquid extracts: 15-30 drops; bark tinctures: 30-60 drops; in honey or water 3-4 times daily.

Cold infusion. 1 teaspoon Oak bark cut, in cup cold water. Infuse 1 hour. Dose: sips during the day. Tincture Cinchona, BPC (1949), 15-30 drops, 2-3 times daily.

Tincture Myrrh BPC (1973) 5-10 drops in half glass water 2-3 times daily.

Oil of Evening Primrose improves brain function in cases of withdrawal (Efamol Can Improve Alcohol Recovery, General Practitioner, p11, Sept 18, 1987).

Milk Thistle. Good responses observed. Dose: 80-200mg, thrice daily.

Chinese Medicine. Kudzu vine (Pueraria lobata) can effectively reduce the cravings of alcohol. The flowers are used in China for alcoholic poisoning. Used for reforming alcoholics. (Herbarium Dec 1993) Supplements. B-complex, A, C, E. Magnesium, Selenium, Zinc. For bone-loss of alcoholism: see: OSTEOPOROSIS.

Information. Alcoholics Anonymous, Stonebow House, Stonebow, York YO1 2NJ. ... alcohol abuse

Suppression of normal menstrual flow during the time of life when it should occur. The most common cause is pregnancy but it can arise from hormonal imbalance, trauma, anaemia, fibroids, polyps, constitutional disorder or emotional problems. Though not prejudicial to health it marks a departure from normal.

Symptoms. Scanty irregular or absent periods.

Alternatives. Agnus Castus, Black Cohosh, Blue Cohosh, Chaparral, Feverfew, Helonias, Life root, Lovage, Marigold, Motherwort, Mugwort, Parsley root, Pennyroyal, Rosemary, Rue, Tansy, Thuja, Southernwood, Wormwood, Yarrow, Hedge Hyssop (Gratiola officinalis).

Tea: Combine: Agnus Castus, Motherwort, Yarrow. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Formula. Combine: Helonias 2; Agnus Castus 2; Blue Cohosh 1. Doses. Powders: 500mg (two 00 capsules, or one-third teaspoon). Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons.

In water or honey, thrice daily.

Agnus Castus. Success reported.

Due to thyroid imbalance: Kelp, Bladderwrack, Irish Moss.

Vitamins: A. B-complex. E.

Minerals: Calcium. Zinc.

Note: Patients with amenorrhoea are at risk of osteoporosis. (Middlesex Hospital, London) ... amenorrhoea

A neurotic and metabolic condition, mostly in young women who suppress appetite by refusing food in an effort to be thin. Such starvation may result in death.

The patient may start as a food faddist with depressive tendencies. Some gorge huge meals (bulimia) and induce vomiting later. Such women are known to be oestrogen deficient; most have a low dietary intake of calcium, resulting in reduced bone density (osteoporosis). Lack of exercise has a worsening influence, often with severe loss of weight.

It is now established that one cause is a deficiency of zinc in the diet. Individuals suffering from the condition (with its depression) may recover when given 15mg zinc daily. Starvation causes increased urinary zinc secretion, thus further reducing body levels of the mineral. Most anorectics complain of loss of sense of taste and smell which is a symptom of zinc deficiency. Loss of these two senses reduces further the desire for food.

Symptoms. Excessive thinness. Anaemia. Poor haemoglobin levels. Absence of menses. Episodic hyperactivity. Slow pulse when resting. Teeth decay, brittle bones. Heart weakness. Low blood pressure, hormonal disorders, yellowing skin, blood disorders, abnormal drowsiness and weakness. Reduced bone density may develop during the illness, the subject being prone to bone fracture for years afterwards. Treatment. Correct anaemia with iron-bearing herbs, Vitamin B12, mineral supplements and nourishing food.

Angelica root, Barberry, Bogbean, Burdock root, Calamus, Centuary herb, Chamomile flowers, Condurango bark, Dandelion (coffee), Garden Sage, Gentian, Ginkgo, Helonias, Hops, Marshmallow root, Milk Thistle, Quassia chips, White Poplar.

Alternatives:– Tea. Formula. Equal parts, Centuary, Chamomile, Peppermint. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. Dose: 1 cup thrice daily, before meals.

Decoction. Formula. Combine Angelica root 1; Burdock root 1; Condurango bark half. 1 teaspoon to each cupful water simmered gently 20 minutes. Dose: Half-1 cup thrice daily before meals.

Powders. Formula. German Chamomile 2; Gotu Kola 1; Ginkgo 1. Dose: 500mg (two 00 capsules or one- third teaspoon) before meals thrice daily.

Tinctures. Formula. Combine: Condurango quarter; Burdock root half; White Poplar 1; Ginkgo 1; add 2- 10 drops Tincture Capsicum fort. 1-2 teaspoons in water thrice daily, before meals.

Tincture: Tincture Gentian Co BP. Dose: 2-4ml (30-60 drops).

Ginger, stem. Success reported.

Milk Thistle and Turmeric: popular in general herbal practice.

Diet. High protein, low fat, low salt. Dandelion coffee. Liver. Artichokes. 2-3 bananas (for potassium) daily.

Supplements. Daily. Vitamin B-complex. Vitamin C, 1g. Vitamin E, 200iu. Zinc, 15mg. Magnesium, 250mg morning and evening. ... anorexia nervosa

Tabashir. Bambousa arundinacea. German: Bambus. French: Bambon. Spanish: Semenedia. Italian: Bambi. Indian: Bansakapura. Arabian: Tabashura. Chinese: Tan-chu. Species of bamboo. Contains 97 per cent silica.

Action: immune enhancer. Aphrodisiac, tonic, pectoral. Calcium-fixer in bones.

Uses: Repair of fractured bone. Of value for osteo-arthritis, rheumatism, stiff joints, cartilage fragility as in osteoporosis, pregnancy, senile dementia, weak spine – tendency to dislocation of vertebrae. Arterio- sclerosis. Brittle hair and nails.

Preparations: Decoction: Quarter of a teaspoon to each cup water gently simmered 20 minutes. Dose: half a cup thrice daily.

Powder. Two 320mg capsules thrice daily (Arkocaps). ... bamboo

May be present at birth or due to infection (osteomyelitis, tuberculosis, etc), fractures from injury or accident, osteoporosis, Paget’s disease (deformity due to mineral deficiency), tumour or sarcoma, osteomalacia, rickets due to Vitamin D deficiency. Brittle-bone disease. Arthritis. See separate entries.

Comfrey decoction. 1 heaped teaspoon to cup water gently simmered 5 minutes; strain when cold; 1 cup – to which is added 20 drops Tincture Calendula (Marigold), thrice daily. Fenugreek seeds may be used as an alternative to Comfrey.

Alternative:– Mixture: equal parts liquid extracts: Comfrey, Marigold, St John’s Wort. One teaspoon in water or honey thrice daily.

Tablets/capsules. Fenugreek, St John’s Wort.

Topical. Comfrey, Fenugreek or Horsetail poultice.

Supplements. Vitamin A, C, E. Dolomite, Zinc.

Supportive. Exposure of site to sunlight.

Comfrey. The potential benefit of Comfrey root outweighs possible risk for bone disorders. ... bone disorders

Fragilitas ossium. A genetic disease where the child is unable to stand because bones of the legs would snap under slightest pressure. Legs may be broken as many as twenty times.

Alternatives. Treatment. Almost one third require major surgery. Herbal nutrition may build up quality of bone from within: Horsetail, Yarrow, Comfrey, Fenugreek seeds.

Powders. Formula: Comfrey root 2; Marigold 1; Horsetail 1; Mix. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula: Comfrey root 2; Horsetail 1; Marigold 1. Dose: 1-2 teaspoons thrice daily. Fenugreek tea. Consume seeds as well as liquor.

Propolis. Regeneration of bone tissue.

Comfrey. It would appear that the internal use of the root could be justified, where its benefits far outstrip its risks.

Diet and Supplements: same as for OSTEOPOROSIS.

Note: Brittle Bone Society, City Road, Dundee. ... brittle bone disease

Pain in the ‘tail bone’ at the base of the spine. Cause usually ascribed to referred pain from lumbar disc tissue, neurosis or spasm of muscles of the pelvic floor. May be due to osteoporosis, old fractures, bony spurs or necrosis of blood vessels. The coccyx receives its blood supply from the median artery, damage to which contributes to avascularity of the coccyx.

Treatment. Osteopathy or plaster jacket immobilisation.

Alternatives. Ladyslipper, Barberry, Valerian, St John’s Wort, Cramp bark.

Powders. Mix, equal parts: Barberry, Valerian, St John’s Wort. 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Hops, Valerian, St John’s Wort. One 5ml teaspoon thrice daily, in water. Practitioner. Tincture Gelsemium: 3-5 drops in water when necessary. For pain. ... coccydnia

Source of minerals for maintenance of nervous and muscle tissue. From deep-mined limestone. A supplement of magnesium and calcium for dietary deficiency. The two minerals work together to maintain normal growth of bone, healthy teeth, efficient heart function and sound collagen structures. Women have a special need of both.

Typical combination. Magnesium carbonate 200mg; Calcium carbonate 240mg. Uses. Mineral deficiencies, osteoporosis, to maintain healthy teeth.

Note: Not used by the elderly or those with digestive weakness.

Dolomite supplements should first be pulverised before ingestion, taken in honey, a bread bolus or other suitable vehicle. ... dolomite

Angelica sinensis, Oliv. Chinese angelica. Dried root. Keynote: conditions arising from disordered female reproductive system.

Action: antispasmodic, analgesic (mild), blood purifier, circulatory stimulant, hormone regulator, nutritive.

Uses: Covers a wide range of female disorders: amenorrhoea, dysmenorrhoea, menopause. Cramps. Hypothermia. Infertility. Sleeplessness, nerve debility, high blood pressure. Toxic shock syndrome.

Asthma. Hay fever. Osteoporosis. Anaemia; particularly in Asian women. To heighten resistance against disease. Avoid in pregnancy.

Preparations: Thrice daily.

Dried root. One heaped teaspoon in cup water gently simmered 20 minutes, dose: half a cup.

Liquid Extract (1:1) half-2ml (quarter to half a teaspoon).

Tincture (1:5) 4-6ml (1-1 and a half teaspoons).

Powder (4:1) quarter to half a gram.

Note: Referred to in the East as “female Ginseng”. Most popular “female” herb in the Far East. ... dong quai

(Metatarsalgia)

Causes: foot-strain, deformity, osteoporosis, high heels throwing the body out of its normal posture, tight shoes.

Feet are often painful because one or more of the bones are out of alignment and which may be adjusted by simple osteopathy. The process can be assisted by foot-baths of Chamomile flowers, Arnica flowers, or Comfrey to relax muscles and tendons.

Alternatives. Alfalfa, Chaparral, Ligvites, Prickly Ash.

Topical. Aromatherapy. (Sensitive feet) Oils of Pine, Eucalyptus or Thyme – 6 drops, any one, to 2 teaspoons Almond oil. Warm. Massage into foot and wrap round with damp hot towel.

General. Acupuncture. Shoes should be bought in the afternoon, particularly if feet swell during the day. Shoes that fit well in the morning may have become too tight by tea-time. ... feet – pain in

Open or closed. In open fractures the skin is pierced; closed, the skin is not broken. As the incidence of neck-of-the-femur fractures associated with osteoporosis increases, with delayed healing in the elderly infirm, herbal mitotics have much to offer. Taken internally with Calcium supplements all kinds of fractures, including hip replacements, are assisted.

Treatment. Acute: give no food or drink in case anaesthetics are needed later. Do not bandage over open fractures. To promote collagen and callous formation: Horsetail, Mouse Ear, Fenugreek, Alfalfa, Marshmallow root, Mullein, Parsley, Comfrey leaves or tincture.

Decoction. Welsh traditional. Equal parts, Comfrey and Horsetail. 1 heaped teaspoon to each cup water gently simmered 20 minutes: half-cup thrice daily.

Dr J. Christopher USA. Equal parts, Mullein, Comfrey, Oak bark, Lobelia, Skullcap, Walnut, Marshmallow root, Wormwood, Gravel root.

Guaiacum. Liquid extract. 5-10 drops in water thrice daily.

Cinnamon. Healing effect on fractures.

Fracture with nerve laceration. St John’s Wort.

Topical. Comfrey paste or poultice.

Diet. High protein.

Supplements. Vitamins A, C, D, E. Calcium citrate malate (more effective than the carbonate), Dolomite, Magnesium, Zinc. ... fractures

Athroplasty. Success rate: high. Commonest indication: osteo- arthritis of hip. A lesser risk of sepsis occurs in first operation than in subsequent ones. Infection is suspected when acetabular loosening is present in conjunction with femoral loosening. Echinacea is the key remedy for combatting infection and for enhancing the patient’s resistance. Comfrey root promotes healing of bone tissue. St John’s Wort gives partial relief in post-operative pain. Horsetail is a source of readily absorbable iron and calcium. For slow healing, a liver agent (Fringe Tree) may be indicated. Alternatives. Teas. Comfrey leaves, Calendula, St John’s Wort, Gotu Kola, Plantain.

Tablets/capsules. St John’s Wort.

Formula. Comfrey root 2; St John’s Wort 1; Echinacea 2; trace of Cayenne (Capsicum). Dose – Powders: 750mg (three 00 capsules or half a teaspoon). Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Effect is enhanced when doses are taken in cup of Comfrey herb tea. Other agents to promote renewal of tissue. Slippery Elm bark, Fenugreek seeds, Wild Yam, Carragheen Moss.

Discomfort from a scar. Aloe Vera gel, Calendula, Comfrey or Chickweed cream or ointment. See: CASTOR OIL PACK.

Diet. High protein, oily fish or fish oils.

Supplements. Vitamin C: 3-6g daily. Calcium ascorbate, Zinc. Magnesium. Cod Liver oil for Vitamins A and D; 2 teaspoons daily.

Note: Where titanium alloy implants are used for this operation serum levels of the metal are likely to show up higher than normal. Raised serum titanium has been linked with lung cancer, osteoporosis, and platelet suppression. A New Zealand study has found deaths from cancer were significantly higher in patients having had a metal hip replacement. See: CHELATION.

Comfrey. Potential benefit far outweighs possible risk. ... hip replacement operation

Within a few years medical scientists have introduced into the domestic scene a steroid which has changed the whole course of female history. HRT has solved some basic medical problems by making good the loss of oestrogen in a woman’s body when menstruation is finished and her body learns to adjust.

A lack of oestrogen induces hot flushes, night sweats, thinning of the bones (osteoporosis) with possible fractures, and a wide range of physical and emotional disorders.

HRT also prevents the increased frequency of coronary disease which may follow the menopause. With oestrogen only, HRT appears to increase the incidence of cancer of the uterine body. Use of oestrogen and progestogen avoids this.

HRT is available as a tablet, transdermal patch, implant or topical cream. Most women notice temporary improvement in their appearance and hot flushes as long as treatment is continued. HRT is not prescribed by the herbal practitioner. Soya and Hops are a mild alternative.

Side-effects of such treatment include blood pressure rise, weight gain and periods probably continue with a monthly bleed. Elderly women taking HRT for osteoporosis may develop bleeding problems, the risk of blood clot and gall bladder diseases.

Helonias has proved a useful alternative, effective in eliminating excess fluids, reducing hot flushes, and relieving that bloated feeling, thus helping the older woman to live a normal life.

Damiana. 1 heaped teaspoon leaves to each cup boiling water; infuse 5-10 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Sarsaparilla. 1oz (30g) root in 1 pint (500ml) water; simmer gently 20 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Supplementation. Daily. Vitamin E, 400iu. Vitamin B-complex (high potency). Evening Primrose oil capsules, 500mg morning and evening. Dolomite, for Calcium and Magnesium, 2 tablets morning and evening.

Note: An extensive study of breast cancer risks with HRT revealed a positive link between the risk of cancer and length of use. Risk of the disease increased with all types of women using HRT with every year of use. Pre-menstrual women were more than twice at risk. It would appear that oestrogens cannot be taken without risk. (Centre for Disease Control, Atlanta, USA) See: OESTROGENS. ... hormone replacement therapy (hrt)

Phytoestrogens. Oestrogens are steroid sex hormones secreted mainly by the ovary, and in smaller amounts by the adrenals, testes and placenta. They control sexual development and regulate the menstrual cycle. In puberty they are responsible for pubic hair and secondary female sex characteristics.

Some herbs, having a similar effect, are known as oestrogenics, and which are given usually during days 1 to 14 of the menstrual cycle for oestrogen-deficiency disorders: night sweats, hot flushes, urinary and menopausal problems.

This group should not be given to patients taking oestrogens of orthodox pharmacy, or in the presence of growths on the female organs: fibroids, endometriosis, cancer, cysts. It has an important role in the metabolism of amino acids, vitamins and minerals.

More than 300 plants are known to possess oestrogenic activity including wholewheat and soya products.

Important oestrogenics: Aniseed, Beth root, Black Cohosh, Elder, Don quai, Evening Primrose, Fennel, Helonias (False Unicorn root), Hops, Liquorice, Sage, Sarsaparilla, True Unicorn root (Aletris). Any one, or more in combination, may be used for symptoms of the menopause or oestrogen deficiency.

The closer we enhance ovarian and uterine function to give true hormone replacement, the more effective is the science of phytotherapy.

See: OSTEOPOROSIS. ... oestrogens

Two female reproductive organs situated below the Fallopian tubes, one on each side of the womb, comparable to testes in the male. An egg cell or ova develops inside the ovary and when mature bursts through the surface into the abdominal cavity where it is attracted into a Fallopian tube and conveyed to the womb. If fertilised, the egg attaches to the lining of the womb and develops into a foetus. Otherwise it is expelled from the womb during menstruation. In addition to producing eggs, ovaries secrete hormones essential to body function. Ovarian disorders include:– 1. Inflammation (oophoritis – usually with salpingitis).

Causes: mumps, tuberculosis, gonorrhoea or, if following childbirth or abortion, sepsis. Inflammatory adhesions may cause ovary and tube to mat together and ulcerate.

Symptoms: feverishness, pelvic pain, abdominal swelling.

Treatment. Decoction, powders, liquid extracts or tinctures.

Formula. Echinacea 2; Helonias 1; Cramp bark 1; Liquorice quarter. Dosage. Decoction: half-1 cup. Powders: one-third teaspoon. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water/honey.

External. Castor oil pack to abdomen.

2. Cysts. Single or multiple hollow growths containing fluids may grow large, obstruct abdominal circulation, interfere with digestion and cause shortness of breath. They are caused by excessive stimulus from the pituitary gland. A fluid-filled sac on the ovary grows in preparation for egg release but fails to rupture. The follicle continues to grow, accumulating fluid and a cyst results.

Liquid Extract Thuja: 5-10 drops, thrice daily. Of value.

Notes. Bulimia Nervosa (eating disorder) has been linked with polycystic ovary disease. (St George’s Hospital Medical School, London)

The presence of acne is a valuable clue to ovarian disorder: a treatment for acne reacts favourably on ovaries.

3. Tumour (non-malignant). May avoid detection. Usually revealed by laparoscopy or X-ray. When a tumour or cyst twists on an ovary’s ligament severe abdominal pain is followed by vomiting and shock.

Treatment. Secondary to surgery. Decoction, powders, liquid extracts, or tinctures. Combination. Cramp bark 2; Poke root 1; Thuja half. Dosage. Decoction: half-1 cup. Powders: 500mg (one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons in water/honey thrice daily.

Following surgical removal of ovaries: Pulsatilla. Pre- and post-operative pain: Cramp bark BHP (1983). Black Willow. (Dr J. Christopher)

Supplements: calcium, magnesium.

Note: Increased bone loss is associated with ovarian disturbances in premenopausal women. (Canadian Study in “New England Journal of Medicine”) See: OSTEOPOROSIS.

Polycystic ovaries have an important association with heart attacks in elderly women. (Professor Howard Jacobs, Middlesex School of Medicine) ... ovaries

An uncommon form of liver cirrhosis that results from problems with the bile ducts, either due to an autoimmune disorder known as primary biliary cirrhosis, or a longstanding blockage. Primary biliary cirrhosis affects mainly middle-aged women and seems to be linked with a malfunction of the immune system. Secondary biliary cirrhosis results from prolonged bile duct obstruction or biliary atresia. In both types, liver function is impaired due to cholestasis (accumulation of bile in the liver). In primary biliary cirrhosis, the bile ducts within the liver become inflamed and are destroyed. Symptoms include itching, jaundice, an enlarged liver, and sometimes abdominal pain, fatty diarrhoea, and xanthomatosis. Osteoporosis may develop. Symptoms of liver cirrhosis and liver failure may occur after several years. Drugs can minimize complications and relieve symptoms such as itching. A liver transplant is the only long-term cure.

The symptoms and signs of secondary biliary cirrhosis include abdominal pain and tenderness, liver enlargement, fevers and chills, and sometimes blood abnormalities. Treatment is the same as for bile duct obstruction.... biliary cirrhosis

n. a metallic element essential for the normal development and functioning of the body. Calcium is an important constituent of bones and teeth: the matrix of *bone, consisting principally of calcium phosphate, accounts for about 99% of the body’s calcium. It is present in the blood at a concentration of about 10 mg/100 ml, being maintained at this level by hormones (see calcitonin; parathyroid hormone). It is essential for many metabolic processes, including nerve function, muscle contraction, and blood clotting.

The RNI (see Dietary Reference Values) for men is 700 mg/day and women 800 mg/day; the National Osteoporosis Society recommends up to 1200 mg/day for individuals with *osteoporosis. The best sources are dairy products (milk and cheese); the absorption from cereals and green vegetables is limited by the presence of phytates and oxalates. Its uptake by the body is facilitated by *vitamin D; a deficiency of this vitamin may result in such conditions as *rickets, osteoporosis, and *osteomalacia. A deficiency of calcium in the blood may lead to *tetany. Excess calcium may be deposited in the body as *calculi (stones). Symbol: Ca.... calcium

a fracture of the distal end of the *radius, which is displaced backwards and upwards to produce a ‘dinner fork’ deformity. *Avulsion of the ulnar styloid process (see ulna) usually takes place as well. It is usually caused by a fall on the outstretched hand. The bone is restored to its normal position under anaesthesia, and a plaster cast is applied for about six weeks. Complications are residual deformity and stiffness of the wrist. If the fall occurs from less than standing height, it is considered an insufficiency fracture and its presence, in the absence of any other underlying cause, suggests *osteoporosis. Early evaluation and treatment for osteoporosis is needed to prevent future fractures. Colles’ fractures are more common in women immediately after menopause. [A. Colles (1773–1843), Irish surgeon]... colles’ fracture

(CRPS, reflex sympathetic dystrophy, RSD, Sudek’s atrophy) neurological dysfunction in a limb following trauma, surgery, or disease, characterized by intense burning pain, swelling, stiffness, and sweaty shiny mottled skin. It is caused by overactivity of the sympathetic nervous system. The *ESR is often elevated, X-rays may reveal some patchy osteoporosis, and a bone scan usually demonstrates increased blood flow. Early treatment with splinting and physiotherapy are essential, in combination with *sympatholytic drugs, corticosteroids, and regional sympathetic blocks; *sympathectomy may be required in chronic cases.... complex regional pain syndrome

n. outward curvature of the spine, which if excessive causes hunching of the back. A mobile kyphosis may be caused by bad posture or muscle weakness or may develop to compensate for another condition, such as hip deformity; it can be corrected by backward bending. A fixed kyphosis may be congenital; it may arise in adolescence (see Scheuermann’s disease); or it may result from collapse of the vertebrae, as in *osteoporosis, ankylosing *spondylitis, infections, or tumours. Treatment depends on the cause and may include physiotherapy, bracing, and surgery (spinal *osteotomy and fusion may be required in severe cases). See also kyphos; kyphoscoliosis.

l... kyphosis

the second most common form of *arthritis (after *osteoarthritis). It typically involves the joints of the fingers, wrists, feet, and ankles, with later involvement of the hips, knees, shoulders, and neck. It is a disease of the synovial lining of joints; the joints are initially painful, swollen, and stiff and are usually affected symmetrically. As the disease progresses the ligaments supporting the joints are damaged and there is erosion of the bone, leading to deformity of the joints. Tendon sheaths can be affected, leading to tendon rupture. Onset can be at any age, and there is a considerable range of severity. Women are at greater risk. Rheumatoid arthritis is an *autoimmune disease, and most patients show the presence of rheumatoid factor or other antibodies in their serum. There are characteristic changes on X-ray. In the early stages there is soft tissue swelling and periarticular osteoporosis; late stages are characterized by marginal bony erosions, narrowing of the articular space, articular destruction, and joint deformity.

Treatment is with a variety of drugs, including anti-inflammatory analgesics (see NSAID), corticosteroids, *disease-modifying antirheumatic drugs, and *biological therapies. Surgical treatment is by excision of the synovium in early cases or by *fusion or joint replacement once bony changes have occurred. (See also hip replacement.) The condition may resolve spontaneously, but is usually relapsing and remitting with steady progression. It may finally burn itself out, leaving severely deformed joints.... rheumatoid arthritis