Outline:
Osteoporosis is a disease with decrease of general bones, manifesting decreased bone weight per unit volume, inadequate production of organic components of bone and secondary decrease of calcium deposition. The disease is classified into two types: primary and secondary. The primary osteoporosis mostly occurs in old people or postmenopausal women, which is related to hypofunction of genital gland and decrease of exercise quantity. The secondary osteoporosis may occur in people of any age. And its development is related to disuse (fixation or decrease activity), weight loss, nutritional disorders (vitamin C deficiency or siderosis), dyshormonism, decrease of sexual hormones, ethylism, liver and kidney diseases, or the uses of medicines such as heparin, corticosteroid, etc.


Major points for diagnosis
1. It often occurs in old people or postmenopausal women.

2. The main clinical manifestations are localized pain, deformity and fracture. The pain mostly occurs in thoracic section and lower lumbar section, and is parallel to the severity of osteoporosis and aggravated when the patient goes upstairs, changes or shakes his body position. Following the development of osteoporosis, there may occur compression fracture of vertebral body, which makes the pain aggravate. The fracture may occur after sudden exertion.

3. The body height is shortened, with kyphotic deformity.

4. Roentgenogram shows no changes at the early stage. When the amount of calcium of bone loses up to 25 %, there may in X-ray film appear decalcification, especially in thoracic and lumbar vertebrae and the pelvis. Vertebral decalcification is characterized by decreased density, vertical palisade arrangement of rare bone trabeculae along stress line and biconcave deformity of vertebrae due to compression of the vertebrae by intervertebral discs and wedge-shaped compression change of one or several vertebrae. The density of the other bones is also decreased. The cortex of tubular bone gradually becomes thinner from the exterior to the interior. And the diameter becomes longer. Both Single Photon Absorptionmeter (SPA) and Dual Photon Absorptionmeter (DPA), and both Single Energy X-ray Absorptionmeter and Dual Energy X-ray Absorptionmeter can precisely assay the content of bone minerals, which can be used for an early diagnosis.


Herbal therapy
Internal treatment based on syndrome differentiation
(1) Syndrome of deficiency of spleen qi

Main symptoms and signs:
Lumbodorsal pain, impaired movement, lassitude of the limbs, humpback, chest distress, shortness of breath, poor appetite, pale tongue with thin and white coating, feeble and forceless pulse.
    
Therapeutic methods:
Strengthening the spleen and replenishing qi.
     
Recipe and herbs:
Modified Shenling Baizhu Powder. Specifically, Dangshen ( Radix Codonopsis ) 12 g, Baizhi ( Rhizoma Atractylodis Macrocephalae ) 12 g, Fuling (Poriae) 12 g, Baibiandou ( Semen Dolicholis Lablab) 12 g, Huaishanyao ( Rhizoma Dioscoreae ) 12 g, Lianzi (Semen Nelumbinis Nuciferae ) 10 g, Yiyiren (Semen Coicis ) 10 g, Jiegeng (Radix Platycodi ) 6 g, Chenpi ( Pericarpium Cirri Reticulatae ) 10g, Sharen ( Fructus Amoral) (to be decocted later) 5 g and Gancao (Radix Glycyrrhizae ) 3 g.
 
(2) Syndrome of deficiency of kidney yin
Main symptoms and signs:
Aching pain in the lower back, lassitude of legs and knees, listlessness, dizziness, amnesia, dry throat and lips, night sweating, flushed cheek, hot sensation in the five centers (palms, soles and chest), red tongue with little coating, thready and rapid pulse.
     
Therapeutic methods:
Nourishing yin and reinforcing the kidney and strengthening bones.
 
Recipe and herbs:
Modified Zuogui Pill. Specifically, Shudihuang (Radix Rehmanniae Praeparata) 15 g, Huaishanyao ( Rhizoma Dioscoreae ) 12 g, Shanzhuyu (Fructus Corni) 12g, Gouqizi (Fructus Lycii) 10g, Fuling (Poriae) 10g, Tusizi (Semen Cuscutae) 10g, Guiban ( Plastrum Testudinis ) 10 g, Lujiao ( Cornu Cervi) 10 g, Niuxi ( Radix Achyranthis Bidentatae ) 10 g, Chenpi (Pericarpium Cirri Reticulatae) 10 g and Gancao (Radix Glycyrrhizae ) 3 g.

(3) Syndrome of blockage of qi activity
Main symptoms and signs: Spasmodic pain or distending pain in the lower back referring to the abdomen, impaired movement of the waist, poor appetite, pale tongue with thin coating, choppy or moderate pulse.
 
Therapeutic method: Regulating qi to alleviate pain.
 
Recipe and herbs:
Modified Liqi Zhitong Decoction.Specifically, Chaihu ( Radix Bupleuri ) 6 g, Danshen (Radix Salviae Miltiorrhizae ) 10 g, Qingpi ( Pericarpium Citri Reticulatae Viride ) 6 g, Zhixiangfu (Rhizoma Cyperi Rotundi Praeparata ) 10g, Xiangyuan (Fructus Citri) 10 g, Zhike (Fructus CitriAurantii) 10 g, Chishaoyao (Radix Paeoniae Rubrae )  10g,  Ruxiang ( Gummi Olibanum ) 10 g, Moyao ( Myrrha ) 10 g, Yanhusuo (Rhizoma Corydalis) 15 g, Lulutong (Fructus Liquidambaris ) 10 g and Gancao (Radix Glycyrrhizae) 3g.

Functional exercise:  
Doing physical work or sports activities appropriately can stimulate activity of osteoblast, which is beneficial to the development of bone. The patient should be encouraged to do more outdoor activities to get more sunshine or ultraviolet ray. The patient in bed rest should also do active or passive activities of limbs, and be encouraged to practice walking as early as possible.

Dietary therapy:  
The middle-aged and old people should be encouraged to correct improper dietary habits, and take the food rich in protein, calcium and vitamin such as fish, egg, dried small shrimps, bean products and spinach.