Ayurvedic Treatment of Osteoporosis, Low Bone Density

The Truth About Osteoporosis

Discover Easy Strategies To Maintain Optimal Bone Health And Reverse Osteoporosis. Here is a quick preview of the valuable information youll have at your fingertips: Statistics can lead to false conclusions. Bone Quality or Quantity? Density or Strength? Find what matters! What happens to unabsorbed calcium? How do prescribed medications fit in the equation? What is the 4-R Program and can it help reverse osteoporosis? What part does protein play in bone health? What contribution does lifestyle make? Am I unknowingly my own worst enemy? What about inflammation and stress? How do they impact my bones?Does an acidic system affect the progress of osteoporosis? Who would suspect this sneaky culprit (in your tap water) as contributing to loss of bone health? Discover 4 easy steps for relieving stress. What part do hormones play in osteoporosis? How to encourage new bone growth. Find 7 steps to a workable exercise program. Look at the whole body. 12 steps to changing habits effortlessly.

The Truth About Osteoporosis Summary


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What Is Osteoporosis

Osteoporosis has been defined by the NIH Consensus Panel 2000 as being a skeletal disorder characterized by compromised bone strength, which predisposes to an increased risk of bone fracture.3 Overall bone strength is comprised of both bone density and the quality of the bone itself.5 The bone density can be measured and quantified as grams of mineral per volume of bone. The bone quality in turn is determined by the bone architecture, turnover, damage and mineralization. Peak bone mass is the amount of bone at the end of skeletal growth, and bone mass will then decrease throughout life.5 Peak bone mass in men tends to be greater than that in women because men have larger bones and current techniques for measurement do not correct completely for this size difference.4 Although the term 'osteoporosis' implies loss of bone density, this may not be the case. For example, men who are hypogonadotropic from birth may never have developed optimal bone density in the first place, so a low bone...

Increased iron intake

Gene have been excluded but mutations of the ferroportin gene may play a role (see above). Iron deposition, as in type 4 haemochromatosis, occurs both in hepatocytes and in reticu-loendothelial cells. Serum ferritin is usually elevated, but transferrin saturation may be normal. The condition occurs in sub-Saharan Africa. It is a cause of hepatic fibrosis and cirrhosis, and associations with diabetes mellitus, peritonitis, scurvy and osteoporosis have been described. The iron overload is associated with a poor outcome in tuberculosis, an infection that is highly prevalent in sub-Saharan Africa.

Cord compression and injury

A R Significant spinal cord injury is assocated with severe trauma, often with head injuries. In the presence of a tumour or vascular malformation, relatively minor trauma can cause severe symptoms. Other predisposing factors include osteoporosis, metabolic bone disease or vertebral disk disease.

The Developmentally Disabled Population

Between 200,000 and 500,000 people in the United States over the age of sixty may have some form of developmental disability. Some of these individuals present special problems as they age. Those with epilepsy appear to be at greater risk for osteoporosis, while those with Down syndrome seem to begin the aging process earlier than others.

Symptomatic treatment

Well-transfused children maintained on a good diet do not usually develop important vitamin deficiency states. However, folic acid deficiency occurs in poorly transfused children or in those with thalassaemia intermedia, and it is probably better to maintain these patients on regular folate supplements. In those who develop iron loading with end-organ failure, endocrine replacement therapy may be necessary to improve growth and secondary sexual development and, if necessary, to treat diabetes mellitus. These children require expert endocrinological assessment before treatment. Because the occurrence of osteoporosis is also likely to be due to hypogonadism, similar precautions should be followed. In those who develop cardiac abnormalities, intensive chelation therapy may improve cardiac function.

Regeneration Screens

Osteoporosis and diseases of bone loss are a major health problem associated with aging. The bisphosphonates have been widely used for the treatment of osteoporosis by inhibiting bone absorption. However, there are no agents that promote bone formation. To facilitate the identification of novel anabolic molecules, a high-throughput in vivo screen using larval zebrafish has been performed in a 6-day time period. Vitamin D3 analogs and intermittent parathyroid hormone were shown to cause dose-dependent increases in the formation of mineralized bone (Fleming et al., 2005). This fast, economical, and genetically tractable screening system provides a powerful adjunct to mammalian models for the identification of bone anabolic agents, and it offers the potential for the genetic elucidation of the pathways involved in osteoblastic activity.

Similarities and Differences Between WS and Aging

Werner's Syndrome is an inherited disease with clinical symptoms (forming a syndrome) that resemble premature aging (87). Early susceptibility to a number of major age-related diseases is a key feature of this disorder. Principal WS features include shortness of stature senile appearance cataracts and graying of the hair beginning at 20 to 30 years skin changes (i.e., tautness, atrophy or thickening, ulceration) designated as scleroderma joint deformities, soft-tissue calcifications and osteoporosis atrophy of muscles and connective tissue early cessation of menstruation and increased incidence of neoplasms. Most of these conditions occur in aging as well but at a later age and with more or less severity (85).

Administration of TSHSuppressive Doses of LThyroxine

Subclinical hyperthyroidism is also associated with high bone turnover 38 , and may induce bone loss according to meta-analyses, especially in postmenopausal women 39,40 . It has not been demonstrated that this results in a higher fracture rate 41 , but again it seems prudent that the endocrinologist monitors the risk in individual patients (by taking a history with respect to the well-known risk factors for osteoporosis, and performing bone densimetry in selected cases) and takes appropriate action in high risk patients (ensuring sufficient calcium intake, and considering supplementation with vitamin D).

Body Composition during the First Year of Life

Considering that the sequential evaluation of body composition is of interest for monitoring and evaluating growth patterns, efficacy of diet and medical interventions, progression of chronic disease, and recovery from malnutrition, DEXA may be considered as one of the gold standards. It is a precise, safe, noninvasive, easy to perform and widely available method providing accurate information not only on FM and FFM but also on LBM, BMC and bone mineral density in infants and toddlers. However, the accuracy of the instrument and software used remain to be validated.

Fracture Neck of femur

Most commonly due to osteoporosis and prevalence of falls in elderly, other risk factors are current smoking, BMI (< 18.5), previous low trauma fracture after 50 years of age and maternal history of hip fracture. Others include hyperparathyroidism, metastases, Paget's disease.

Radiographic features

Sacro-iliac joints radiographically on initial presentation. This is usually a bilateral and symmetric process initially affecting the iliac side of the joint, and progressing along the inferior synovial portion of the joint. The initial signs are osteoporosis, loss of cortical definition, superficial erosions and focal sclerosis with eventual obliteration of the sacro-iliac joint space with resultant bony ankylosis 5 (Fig. 4.30).

Gonadotropin Releasing Hormone Analogs

Gonadotropin releasing hormone analogs (GnRH) cause a temporaty medical menopause resulting in hypogonadism and hypoestrogenism by acting on the pituitary to reduce gonadotropin synthesis and secretion. Most of the side effects experienced occur because of the hypoestrogenic state including hot flashes, vaginal dryness, mood lability and decreased libido. The GnRH agonists have been shown to work well in reducing pain symptoms associated with endometriosis such as dys-menorrhea, dyspareunia, and noncyclic pelvic pain. GnRH agonists are often initiated with the onset of menses, but a more rapid response is observed with mid-luteal administration. A limit of 6 months per treatment course is required due to loss of bone mineral density during therapy, but this can be extended via the addition of 'add-back' therapy with estrogens. Retreatment with these drugs is supported by limited data. Several investigators have studied the use of GnRH agonists as surgical adjuncts. Their use...

United States Preventive Services Task Force Recommendations

Recommendations for population-based screening that earned grade A (strongly recommended) or grade B (recommended) in a 2006 review for adult men and women are the following obesity, depression, and high blood pressure screening for persons of all ages, syphilis screening for persons at increased risk, colorectal cancer screening at age 50, diabetes type 2 screening for adults with hypertension or hyperlipidemia, and lipid disorder screening per age and gender (men, age 35 women, age 45) (Guide to Clinical Preventive Services, 2006). Additional procedures are recommended for women breast cancer screening (mammography) at age 40, cervical cancer screening if sexually active, chlamydial infection screening women 25 and younger or at increased risk, and osteoporosis screening for women 65 or older, postmenopausal, or at increased risk for osteoporotic fractures. Men age 65-75 with a history of ever smoking should be screened for abdominal aortic aneurysm via...

The Role Of Ligand In Steroid Receptor Mediated Signal Transduction

In the presence of the SERM tamoxifen, however, the C-tail of ER is positioned in a manner that it occludes this coactivator binding pocket so that a productive association with the cellular transcription apparatus is not possible. In addition to tamoxifen, there are several additional SERMs that manifest distinct activities in vivo. One of these compounds, raloxifene, has recently been approved as a SERM for the treatment of osteoporosis. This compound is different from tamoxifen in that it does not exhibit estrogenic action in the postmenopausal endometrium. Although clearly biologically different, tamoxifen and raloxifene were found to have very similar profiles in the protease digestion assay. In addition, the crystal structures of the ER-tamoxifen and ER-raloxifene complexes were shown to be virtually indistinguishable. Initially, these results appeared to be at odds with the hypothesis that linked receptor structure to function. However, some...

Recommended Evaluation And Treatment

Given the high incidence of bone mineral density loss in men with prostate cancer undergoing hormone therapy, we recommend baseline evaluation with a DEXA scan (Fig. 44.2). If the baseline scan is normal, no further evaluation is necessary at that time and a follow-up scan should be performed in 1-2 years. If the scan is abnormal, then treatment should be discussed with the patient, explaining the risks and benefits of treatment. Our initial medical treatment for osteopenia is bisphosphonate therapy at osteopenic doses, vitamin D and calcium. Currently, we use alendronate 35 mg once a week, and vitamin D 400 IU or more, and calcium carbonate or citrate 1000 mg daily. The vitamin D and calcium are often available as a combination marketed specifically for osteoporosis. The initial treatment for osteoporosis is identical except for increasing the dose of bisphosphonate, in this case to alendronate 70 mg weekly. According to the NIH Consensus Conference 2000, both alendronate and...

Suppression of orbital inflammation in dysthyroid eye disease

Systemic steroids at high dosage (either intravenous methyl prednisolone or oral prednisolone) should be administered and the patient checked for improvement after a few days. The patient should be monitored for hyperglycaemia and hypertension during treatment and the prescription of a gastric proton-pump inhibitor or Histamine-2 receptor antagonist considered patients on long-term steroids, especially the elderly, should be given calcium supplementation to counteract steroid-induced osteoporosis. If systemic steroids produce an improvement in the inflammatory orbitopathy, the dosage should be slowly reduced towards about 20mg daily if possible and the patient referred for low-dose, (2000-2400 cGy) lens-sparing radiotherapy to the posterior tissues of the orbit some authors consider radiotherapy contraindicated in diabetics, as it may hasten the development of retinopathy.

Selective Interventions

Appropriate selective interventions for other target conditions, such as diabetes mellitus, coronary artery disease, some types of cancer, osteoporosis and sexually transmitted diseases, should be recommended in accordance to the standard of care in the applicant's country of

Genomics the Human Genome Project and Other Genomes Bacterial

Several examples of the use of genomics to discover new drug targets are beginning to emerge. One such example is the discovery of cathepsin K, a new member of the cysteine protease family that was identified by analyzing new gene sequences from a cDNA library produced from osteoclast cells, cells involved in bone resorption. Subsequent studies indicated that inhibition of this protease may provide a novel therapy for osteoporosis. New chemical entities to inhibit this enzyme are being produced using combinatorial chemistry and structure-based drug design, new technologies that are described later in this chapter (see Section 5.).

Ulcerative colitis continued

Gastrointestinal Haemorrhage, toxic megacolon, perforation, colonic carcinoma (in those with extensive disease for > 10 years), gallstones and PSC. Extra-gastrointestinal manifestations (10-20 ) Uveitis, renal calculi, arthropathy, sacroiliitis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, osteoporosis (from steroid treatment), amyloidosis.

Extension teardrop fracture

This is usually the result of a hyperextension injury caused by a force delivered to the face or the mandible that drives the head and neck into an abnormal extension. The extension teardrop fracture is a relatively large triangular fragment with its vertical height equal to or greater than its transverse width. The fractured fragment usually arises from the antero-inferior corner of the involved vertebra, most commonly the C2 vertebral body (Figs 4.47 and 4.48). This is an avulsion fracture at the site of insertion of the intact anterior longitudinal ligament during hyperextension of the head and upper cervical spine. Extension teardrop fractures are more common in older patients with osteopenia and degenerative disease of the spine. This is usually a stable injury in flexion and unstable in extension 2, 6 .

Tendon Healing To A Bone Surface

Injuries of the rotator cuff tendons in the shoulder are among the most common problems that cause shoulder pain and dysfunction in adults. Cuff tear can be partial- or full thickness, acute or chronic, and traumatic or degenerative (56,57). Rotator cuff surgery is considered when nonoperative treatment fails to reduce pain and does not improve shoulder function. The most common types of surgical treatment for rotator cuff tears include open or arthroscopic repair that involves reapproximating the tendon edge to a bony surface of the humeral head. In cases of complex or irreparable tears, tendon transfers are often performed (58-60). The major goal of a rotator cuff repair is to provide a sufficient initial strength of fixation to allow appropriate rehabilitation during early stages of the healing process when the tendon-bone interface is still weak and complete functional recovery has yet to take place. However, high failure rates of the rotator cuff repairs remains a significant...

The Scope Of The Problem In Prostate Cancer

We became aware of the problems of bone mineral density loss when, within the space of 1 year, three of the author's patients suffered hip fractures. We then began to evaluate our patients who were being treated with androgen deprivation therapy (ADT) with DEXA scans. Of our 75 patients studied to date, 70 were on leuprolide therapy and five had undergone bilateral orchiectomy.10 All patients underwent an in-office screening DEXA scan utilizing the fourth digit of the nondominant hand. When this proved abnormal, a full table body scan of the hip and spine was performed for comparison. The patients' ages ranged from 46 to 98, with a mean of 76.4. The patients' duration of ADT ranged from just beginning treatment to 13 years on therapy, with an average of 3.35 years. Of the entire series, only 34 (45.4 ) had a normal bone mineral density. Of the 41 patients with abnormal DEXA scans, 25 (61 ) had osteopenia, while 16 (39 , or 21.3 of the entire group of 75 men) had osteoporosis. When we...

Telomeres and Premature Aging

The reduced-longevity and premature-aging phenotypes of mTR- - mice are even more pronounced when combined with a deficiency in WRN (Chapter 3), the gene that is defective in the human premature-aging disorder, Werner syndrome (WS) (148). WRN encodes a DNA exonuclease helicase that participates in several processes important for genomic stability, including telomere maintenance (149). Humans with WS develop multiple aging phenotypes (e.g., wrinkled skin, thin gray hair, cataracts, osteoporosis, type II diabetes, cancer)

Granulocyte and granulocytemacrophage colonystimulating factors

Severe chronic neutropenia is defined as an absolute neutro-phil count below 0.5 X 109 L lasting for months or even years. Causes include cyclic, idiopathic and congenital neutropenias, and G-CSF has been shown to be effective in all these categories, leading to durable responses in the neutrophil counts. In the case of inherited bone marrow failure syndromes such as Kostmann's syndrome, Schwachman-Diamond syndrome, Fanconi anaemia and dyskeratosis congenita, G-CSF may be effective in improving neutrophil counts in up to 90 of cases and may also reduce infections and improve survival these infants previously suffered from severe pyogenic infections and had a median survival of less than 3 years. Adverse effects include mild splenomegaly, mild thrombocytopenia, osteoporosis and possibly malignant transformation.

Opg Report Where Tumor Detected

The C4-2 osseous model and its response to castration were also characterized (102). C4-2 tumors had a 100 take rate in bone and caused radiographically lytic expansile lesions. C4-2 cells decreased bone mineral density and bone volume of the injected tibiae vs normal tibiae. Castration caused a drop in serum PSA with a nadir at day 14, after which it began to rise again. Bone destruction in the tumorous tibiae of castrated animals was decreased by 15.9 vs tumorous tibiae of intact animals. There are multiple reports of use of the SCID-hu model. The first reported use of this model to evaluate new treatment modalities was published by Nemeth et al. (106). The authors showed that matrix metalloproteinase activity was associated with PC-3 cell proliferation in bone, and that daily treatment with batimastat, a broad-spectrum matrix metalloproteinase inhibitor, hampers osteolysis associated with the growth of these cells in the bone environment, as well as tumor growth. Cher et al. (107)...

Changes in Balance and Falls

Diagram Demonstrating Sleep Stages Eeg

Experiments in which they are tested in moving platforms with sensory input (primarily vision) absent. The elderly are much less tolerant of any loss or decline of sensory input (such as vision) (15,24). Falls of the elderly occur when engaging in ordinary activities, most often indoors. Trips and accidents account for the largest number of falls. It is to be noted that the incidence of falls declines with further aging, probably due to the reduced mobility of the very old. Some falls occur without any external cause and may be due to impaired peripheral (ocular, vestibular, and proprioceptive) and central (cerebellar and cortical) coordination (24) or, especially in postmenopausal women, to bone fractures due to osteoporosis (21) (Chapters 10 and 20). more severe osteoporosis and bone fragility, especially after menopause (Chapter 10), Comparison among ethnic groups in the United States indicates few differences in the increasing frequency and severity of motor disabilities,...

Evaluation of Body Composition

Nome Dos Componentes Microscopio

In contrast, DEXA requires minimum radiation exposure (< 0.3 mrem) and performs whole body rather than slice measurements. Given the short scanning time (6-10 min) this method is becoming the most widely used method for the in vivo measurement of whole body composition in humans. Determinations are performed without sedation, but the naked infant is swaddled in a paper blanket to minimize the movement artifact. During a DEXA determination an X-ray source generates two different energy levels and, depending upon the differential absorption of the two photon emissions, body composition (lean mass, FM, bone mineral density) is determined. In addition, total bone area is also determined and BMC can be calculated. However, the accuracy and precision of the determinations may be affected by the type of DEXA instrument 1 , scan mode 20 and software programs used 21 . Using the QDR 2000 (Hologic Inc., Waltham, Mass., USA) equipped with an infant table pad and the infant whole body software...

Hormones and Aging

Another hormone that greatly influences human behavior and development is human growth hormone (HGH). This hormone is produced by the anterior pituitary (adenohypophysis) gland under the control of the hypothalamus. HGH production peaks during adolescence, corresponding to the growth spurt. While it is produced throughout life, it declines with age in all species studied to date. In humans, HGH production tends to drop quickly beginning in the thirties so that by age sixty, HGH production is only about 25 percent of what it was earlier in life, and it continues to decline until death. The decrease in HGH production with age has been tied to thinning of skin and wrinkle formation, muscle wasting, sleep problems, cognitive and mood changes, decreased cardiac and kidney function, lessening of sexual performance, and weakening ofbones, contributing to osteoporosis. Nutritional supplements including the amino acids arginine, lysine, and glutamine are being investigated as growth hormone...

P53 Mutant Mice

(151), whereas the other expressed a naturally occurring isoform (152). p53 forms a tetramer, and both short p53 proteins appeared to integrate into tetrameric p53 and increase its activity. Not surprisingly, both mouse models were remarkably tumor free. Surprisingly, though, both were short lived and prematurely developed aging phenotypes including gray hair, thin skin, osteoporosis, cataracts, and diabetes. Cells from these mice were also more prone to apoptosis (151) and senescence

Example 104

A variety of organ systems affect the stability of the bone. Calcium homeostasis, regulated primarily by the parathyroid hormone and vitamin D, controls the amount of calcium stored in the bone. Loss of homeostatic control can cause excessive release of stored calcium in the bone, resulting in osteoporosis. Because lead is sequestered in the bone, release of calcium from the bone can also result in the release of lead from prior exposures. Toxic effects on the bone can also affect the ability of the red bone marrow to produce red and white blood cells. Ionizing radia-

Whats Representative

The needs of women aged 66 years or over are already represented in regulatory drug testing guidelines in the elderly Federal Register (1990), but women 50-65 years old also can lay claim to special consideration, given the special problems associated with combined hormonal loss and age changes (e.g. osteoporosis, loss of possible cardiac estrogen protection and changes in body fat composition and its distribution). Pregnant women, already isolated from drug development by fear of legal tort laws and, indeed, by their physicians' reluctance to even prescribe in early pregnancy, can also stake a claim to require additional studies. Finally, when studying females of child-bearing potential, should we include patients on oral contraceptives, with their large levels of regulated fluctuating but synthetic hormones, or rely on females not taking oral contraceptives The latter option will increase the risk of potential fetal exposure.


Osteoporosis in the male is a newly appreciated problem. Long associated with the aging woman, osteoporosis is now known to affect more than 2 000 000 American males over the age of 50 at this time, with another pool of 3100 000 men who are at risk for developing it.1-5 About one out of every eight men over the age of 50 will at some point have an osteoporosis-related fracture.6'7 Every year about 100000 men will suffer an osteoporosis-related hip fracture, one-third of which will die within the year. In addition tens of thousands of men will have a fracture of the wrist, spine or rib. Physicians who treat men need to be increasingly sensitive to this problem. Thirty-six per cent of the osteoporosis in men is due to low androgen levels, which can occur as a result of hypogonadism that is either congenital, as part of the aging process, or due to acute androgen deprivation, such as in the treatment of advanced carcinoma of the prostate.8 In the latter case, given the usually advanced...

Anorexia Nervosa

Complications of Anorexia Nervosa. All body systems may be affected, depending on the degree of starvation and the type of purging. Leukopenia and anemia, dehydration, metabolic acidosis (due to vomiting), or alkalosis (due to laxatives), diminished thyroid function, low sex hormone levels, osteoporosis, bradycardia, and encephalopathy are commonly seen.

Clinical Need

Tions, including osteoporosis (10 million U.S. patients), Alzheimer's and Parkinson's diseases (5.5 million patients), severe burns (0.3 million), spinal cord injuries (0.25 million), and birth defects (0.15 million), as targets of regenerative medicine (Research, 2002).

Available Doses

Flashes, favorably effect lipid profiles and increase bone mineral density (BMD). Black cohosh or remifemin is another popular herbal medication that has been used to treat menopausal symptoms. Clinical trials show that it is superior to placebo for relief of hot flashes and short term safety data are reassuring. However, many of the efficacy studies are open label and there are no long term safety studies, particularly with respect to effects on breast and endometrium. Finally, vitamin E at a dose of 800 IU daily has been shown to be only slightly more effective than placebo in the treatment of menopausal symptoms. Further study is needed in this area to determine whether there is a definitive benefit from these forms of therapy. Osteoporosis Osteoporosis is defined pathologically as an absolute decrease in the amount of bone, resulting in an increased risk of fracture with minimal trauma. It is a major long-term health risk associated with the loss of estrogen from the menopause....

Vitamin D

DEFICIENCY Causes hypocalcemia and hypophosphatemia, with resultant rickets (bending with poor calcification of developing bone in children) or osteomalacia (decalcification and softening of bones in adults). In both of these there is impaired mineralization. These should be distinguished from another condition, osteoporosis, in which there is reduction in bone mass as a whole, rather than select reduction of the mineral content.

Ovulation Induction

Polycystic Ovarian Syndrome Etiology

Clomiphene citrate (CC) is an estrogen analog that was first shown to induce ovulation in 1961 and was approved for clinical use in the United States in 1967. Clomiphene belongs to a family of compounds known as selective estrogen receptor modulators (SERMs). Other well-known SERMs include tamoxifen (breast cancer treatment) and raloxifene (osteoporosis treatment). Clomiphene is used for ovulation induction or controlled ovarian hyperstimulation in patients with normal endogenous estrogen levels.

Black cohosh root

Black cohosh was one of the medicinal plants widely used by various American Indian tribes and adapted by early European settlers as a treatment for rheumatism. The use of black cohosh for menopausal symptoms became widespread during the 1800s in both America and Europe. At present, virtually all significant clinical and laboratory investigation on black cohosh have been performed by European investigators. Numerous clinical trials, including randomized controlled trials, have compared Remifemin with placebo and a variety of estrogen preparations commonly used as hormone replacement therapy for women. It is now well documented that this herbal preparation effectively reduces hot flashes in women. Remifemin also appears to be effective in countering the depression, insomnia and other psychiatric complications of female menopause. In addition, this black cohosh extract appears to prevent bone loss in animals after surgical removal of the ovaries, raising the possibility that it might...

Specific Hormones

Kallmann Syndrome Penis

EXCESS Cushing's disease specifically refers to the clinical effects of increased ACTH secretion (and hence secondarily increased adrenal corticosteroid production) from a pituitary tumor. Cushing's syndrome is a broader term, referring to the results of excess corticosteroids, whether it be due to a primary oversecre-tion by the pituitary or adrenal, or chronic administration of corticosteroids (the most common cause). As a result of the increased output of glucocorticoids, there are obesity, buffalo hump deformity, moon-face, stria, osteoporosis, myopathy, psychosis, and diabetes from abnormalities in the metabolism and distribution of carbohydrates, proteins, and fats. The antiinflammatory effect of the glucocorticoids adds the symptoms of decreased inflammatory response. The ex-

David J Reich

Long-term immunosuppressive therapy is a significant risk factor for renal dysfunction, hypertension, diabetes mellitus, hyperlipidemia, obesity, osteoporosis, malignancy, and infection. Although the toxicity profiles of individual immunosuppressive regimens differ, all transplant recipients are prone to develop these problems. As more immunosuppressant agents come into use, various combination regimens are being used to reduce toxicity. Although many transplant recipients are malnourished before transplantation, excessive weight gain frequently occurs after transplantation. Risk factors include increased caloric intake, decreased physical activity, corticosteroid use, and coexistence of diabetes mellitus. Managing obesity is particularly important because this complication is itself a significant risk factor for development of the other complications of hypertension, diabetes mellitus, hyperlipidemia, and osteoporosis. Managing posttransplant obesity requires dietary restriction,...