Gain bone at early age, forget pain at old age

When we talk about geriatric problems, osteoporosis is the prime topic. Osteoporosis is loss of bone tissue, resulting in bones that are brittle and liable to fracture. Infection, injury and synovitis can cause localized osteoporosis of adjacent bone. Generalized osteoporosis is common in the elderly and in women often follows the menopause. It is also a feature of Cushing’s syndrome and prolonged steroid therapy.

 

Many aged remain unaware of this underlying demon. Most of the times this problem is brought to notice by a bone fracture occurred due to a simple trauma. Females face osteoporosis earlier than males. In females loss of calcium and minerals begin often at the age of 30, where as in males it occurs after 60. In females it accelerates around the age of 45, as estrogen level falls down at menopause. 30% calcium is lost by the age of 70. Once bone loss begins, in females 8% loss occur every 10 yearly, where as in males 3% loss per 10 year occurs.

 

Osteoporosis leads to too many problems like brittle bones, bone fractures, non union of fractures, pain etc. In old age, many therapies are inconvenient for patients, so it is advisable to prevent osteoporosis changes right from the early age. Wealth is of no use if one doesn’t have good health to enjoy the life. So, a little care for our bone health from young age will be definitely be a worth and wise investment for happy life after retirement.

Composition of bone

 

Bone is a live tissue. About 80% of human skeleton is compact bone and 20% spongy bone. Adult compact bone contains about 75% inorganic and 25% organic materials. Bone contains mainly calcium, magnesium and phosphorus as its inorganic material, in which calcium is the major.

 

According to Ayurveda, bone i.e. Asthi (bone tissue) is the 5th dhatu in our body. Bone has Panchabhautic constitution and it exhibits properties of Prithvi mahabhuta more prominently. Asthi is one of the destinations of Vayu (Vata sthana). The Vayu and Asthi are inversely proportional to each other. That means when Vayu increases in Asthi, Asthi decreases, and vice versa.

Growth & Development of Bones

Bones calcify through the process of ossification. Activity of epithelial plate is the way that the bone can increase in length. 99% of total body calcium is in bones. The status of calcium is not stationary, but it is continuously recycling. The calcium of the bone is in dynamic equilibrium with the calcium in extra cellular fluid (E.C.F.), i.e. the calcium leaves the bone to enter E.C.F. and the same time the E.C.F. calcium deposits in the bone resulting in no net loss or gain in the total calcium of bone. This is seen in adults and called as calcium equilibrium. In growing child positive calcium equilibrium is observed. That means, new bone formation is more than the depletion of bone in the remodeling. While in elderly person, negative calcium balance is observed where bone loss is more than the new bone formation.

 

Many factors other than calcium play an important role in bone development, like Vitamin D, A, C, K, B12 & Para thyroid hormone (PTH) Calcitonin.

 

Need of early age bone care

 

As mentioned earlier, positive calcium balance is observed in young age, calcium equilibrium is observed in middle age and negative calcium balance is observed in old age. That means if one wants to buildup a good health of bones, the young age is the most ideal period. Efforts in middle age may also be fruitful. But as an old age is a degenerative stage, even vigorous efforts to boost body components may not prove encouraging.

In reference to the Rasayana i.e. rejuvenating treatment, Ayurveda has clearly mentioned to have Rasayana at young age or middle age. Though the target is to prevent disorders at geriatric age, the treatment is prescribed at the developing age of the human body.

 

If we consider the stage of Dosha at different age groups, in young age Kapha Dosha is prominent which is responsible for cumulative and integrative action. In middle age pitta Dosha is prominent whereas in old age Vata Dosha is prominent. As Vata is inversely proportional to the Asthi, efforts to treat osteoporosis at elder age are comparatively less effective. On the other hand if we follow the principle of Rasayana and start Rasayana for bones at young age or middle age, it will be beneficial for life long. Not only for bones, but also this theory is applicable for all dhatu and whole body.

 

So, attention towards early age management of geriatric problems like osteoporosis is essential. Early age bone health care is not only important in point of view of prevention of osteoporosis, but also it is important in primary growth and development of child. Because few things are irreversible and that is why one should take care when formation is going on. Like development of teeth and height that are closely dependant on development of bones.

 

How can one take care of bones?

 

In order to gain a good bone health following few points plays an important role.

·         Sufficient intake of nutrients

·         Absorption of nutrients

·         Transportation of nutrition to desired sight

·         Appropriate formation of the target tissue / dhatu.

Accessory or accompanying components like Prakriti, age etc.

 

a) Nutrients for Asthi (bones)

Drugs having similar constitutions as Asthi are useful for the nutrition of Asthi. For example, calcium rich diet like milk and milk products, eggs, fish, green leafy vegetables like spinach, amaranth; cereals, millets, some fruits like custard apple (Sitaphal) provide good calcium supplement. An additional source of calcium is drinking water which may provide up to 200 mg/day. Also the plant drugs having their core boney hard are used to strengthen the bones. For example, khadir (Acacia catechu), Babbul (Acacia arabica), Laksha (Laccifer lacca), asthisandhanak (Cissus quadrangularis) etc. Medicines rich in natural calcium like Mukta, praval and Pishti, Shukti  etc. are used to compensate deficiency.
 
b) Jatharagni & Digestion of food

 

Food is the main source of calcium and other essential nutrients. Agni is the digestive power in the body. It is the factor responsible for any transformation in the body. Jatharagni digests the food and makes it available for the absorption in body.

The custom of Tambul bhakshanam (Chewing of Betel leaves) is also based on the activity of Agni.(We don’t promote today's practice of eating betel leaves with pan masala). Calcium absorption and its deposition on bone are naturally increased at meal time as the action of Agni. There is the custom to have Tambul after meals. Tambul contains lime, catechu and betel leaves. This provides good calcium supplement and nutrition to bones. Catechu used in Tambula is also an important herb for bones. Tambula  helps to improve the appetite and digestion. Other common drugs used to improve Agni are Jiraka (cumin), Maricha(pepper), Shunthi (dry ginger), Misreya (fennel) , Chitraka (Plumbago zelanica) etc.
 
c) Grahani & absorption of nutrients

 

Native place of Agni or pitta is ‘grahani’ which is anatomically compared with duodenum. The well function of grahani is said to be responsible for good digestion of food. Also it functions for differentiation of nutrients and waste products, absorption of nutrients, formation of malas (urine and faeces) etc.

 

If the dietary calcium intake is low, the absorption of calcium by intestine becomes very avid. Whereas when the dietary calcium intake of the calcium is high, the intestinal calcium absorption becomes poor. Thus the Grahani regulates the nutrition by adjusting the absorption of calcium.

 

d) Bhrajakagni &Vitamin D

 

Bhrajakagni is the digestive power that digests the nutrients from skin and make it available for body. Vit. D is formed under skin in presence of U.V. rays in sunlight. Small intestine and bones are the principal target organs. So, the Bhrajakagni should be optimum for proper formation of vitamin D. Also enough exposure to the sunlight is essential. Massage with oil and then fomentation with steam or warm water is also a good exercise to worship the Bhrajakagni. Food material like liver, egg yolk, butter, cheese, milk and other milk products, fish, fish liver oil are helpful when consumed as vitamin D supplement.

 

e) Dhatwagni & formation of target

 

Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Shukra are the 7 dhatu that constitute the body. Nutrient material from the digested food is separated in grahani and picked up in the circulatory system. Saptadhatwagni (agni in each dhathu) works for digestion of useful component of digested food for the formation of respective dhatu. Asthi dhatwagni digests nutrients for the nourishment of bones.

It is not important what level of calcium is in the blood serum, but the most important thing is its usable fraction and the dhatwagni that makes it available for use in body. If it is not proper, in spite of adequate blood calcium level, one may suffer from calcium deficiency symptoms. Some specific drugs like Asthishrinkhla (Cissus quadrangularis), Laksha (Laccifer lacca) are used to improve Asthi Dhatwagni.
 
Healthy habits to keep osteoporosis away
a) One should take care of his nutrition and Agni as mentioned above. Apart from that -
b) Exercise: Proper exercise certainly improves bone health. Bones undergoing stress are remodeled as a tough one. Exercise like jogging, weight lifting, sit ups and other weight bearing exercises can help a lot. Heavy exercise should only be done under expert guidance.
c) Snehana: As Asthi and Vata are in inverse proportion, use of Sneha like massage with oils, ghee are useful to reduce hollowness of bones. Snehanea in the form of Nasya, Basti, Abhyanga and internal consumption is useful. Swedana (fomentation) followed by Snehana is also useful.
d) Menopausal osteoporosis: In case of females, special attention should be given. Because hormonal imbalance at menopause is responsible for osteoporosis. Treatment for menopausal syndrome must be followed along with above mentioned things.

 

By : Dr. Pranit Ambulkar M.D., P.HD Scholar, NIA