Table of ContentsView AllTable of ContentsDietExerciseLifestyle ChangesAcupunctureMedicinal HerbsMelatoninTai ChiFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Diet
Exercise
Lifestyle Changes
Acupuncture
Medicinal Herbs
Melatonin
Tai Chi
Frequently Asked Questions
Traditional treatment options forosteoporosisinclude fall prevention, exercise, adequate nutrition, and medications. In addition to traditional options, natural remedies may be beneficial. The goal of treating osteoporosis is to prevent further bone damage.
Some bone loss is a natural part of aging, but hormonal changes, family history, and certain lifestyle factors, such as a poor-quality diet and smoking, can contribute to osteoporosis.
This article investigates natural treatment options that can be utilized in the treatment and management of osteoporosis.
skynesher / Getty Images.
Osteoporosis Diet
Bone building occurs during childhood; people experience peak bone mass sometime during their 20s.To prevent osteoporosis, it is important to achieve peak bone mass, which requires eating a nutritious diet that contains foods rich in calcium, magnesium, selenium, vitamin K, vitamin D, and protein. To treat osteoporosis, you still need to get enough of these nutrients.
What to Eat
Some experts recommend considering your total dietary pattern rather than focusing on specific nutrients in isolation.That’s because getting a variety of nutrients is important for bone health.
Foods rich incalciumandvitamin Dare key for building bone and maintaining bone strength.Calcium-rich foods include dairy products (cheese, yogurt, milk, and fermented milk products). Dairy products also contain other nutrients important for bone health, including protein, magnesium, phosphorous, and vitamin B12.
If you do not eat dairy, you can choose foods fortified with calcium, including yogurt alternatives, nut-based milks, orange juice, cereals, and tofu. Salmon and fish with bones, like sardines, contain calcium. Plant-based calcium sources include kale, cabbage, and other leafy green vegetables.
Vitamin Dis responsible forcalciumabsorption. It is found naturally in only a few foods but can also be made in the body from sun exposure.People who are deficient in vitamin Dmay need to take a supplement.
Food sources of vitamin D include fatty fish (such as trout, salmon, tuna, and mackerel) and fish liver oils, beef liver, egg yolks, fortified milk, other fortified foods (milk alternatives, breakfast cereals, juice), and mushrooms treated with ultraviolet (UV) light.
Certain minerals, such asmagnesiumandselenium, can also impact bone health.Natural sources include pumpkin seeds, sweet potatoes, cashews, beans, spinach, peanuts, Brazil nuts, chicken, fish, and shrimp.
These foods are also rich inprotein, a macronutrient that plays a role in bone volume, mass, mineralization, and formation.Otherproteinsources include whole grains, soy, and animal products like eggs, dairy, and beef.
Soybean foodsare sources of soyisoflavones, which have estrogen-like activity and are calledphytoestrogens. Some studies show this may be beneficial for bone health.Soybean foods high in isoflavones include soybeans, edamame, miso, natto, tempeh, and tofu.
Lastly, foods rich invitamin Candvitamin Kcontribute to healthy bones.Foods rich in vitamin Cinclude citrus fruits, berries, peppers, tomatoes, fortified juice, and cruciferous vegetables (in which vitamin K is also found).
Vitamin D Deficiency
Eating a variety of foods is important for bone health and will help you meet your nutrient requirements for each vitamin and mineral. If you are concerned that your diet is lacking, you can meet with a healthcare provider to discuss supplementation (if needed).
What to Avoid
Too much alcohol and sodium may interfere with how your body metabolizes and absorbs calcium and vitamin D, which are important for bone health.
It’s uncertain theimpact specific amounts of alcohol have on bone. However, experts know that alcohol can impact the way calcium and vitamin D function.Therefore, the National Institute on Aging recommends drinking in moderation, if at all.
The verdict on sodium intake and bone health is controversial. Some studies suggest too much sodium can increase calcium excretion, while other studies show that ingesting more than 2,300 milligrams (mg) of sodium daily does not increase the risk of osteoporosis.Intake below that level is suggested for people with high blood pressure.
Nevertheless, the Bone Health and Osteoporosis Foundation recommends limiting processed foods high in sodium, like snack foods.
Some studies have found a link between a high intake of soft drinks, especially cola, and an increased risk of fractures.Colas contain phosphoric acid, which may reduce calcium in the body. But this area of research is not yet conclusive.
Weight-bearing exercise helps improve bone strength in youth and adolescence. Weight-bearing exercise in adulthood aims to build strength and muscle mass, improve coordination and balance, improve daily function, and delay loss of independence associated with osteoporosis.
Specific weight-bearing exercises and activities include squats, step-ups, lunges, jumping rope, jogging, hiking, and stair-climbing. It is recommended to start under the guidance of a healthcare provider (if you are not already used to exercising) to avoid injury or pain.
Exercises for Osteoporosis
Smoking, being inactive, and drinking too much alcohol can increase the risk of bone loss.If you smoke, consider getting help in quitting. Reduce your alcohol consumption if you drink more than moderately.
Aim to move daily; walking is a great exercise to start with. Regular checkups with your healthcare provider are also important for assessment and treatment.
In a meta-analysis published in theAmerican Journal of Chinese Medicine,researchers found that warm-needle acupuncture—in which burning moxa cones, a compacted form of mugwort herb, are placed on the handle of the needle after insertion—could increase the bone mineral density of specific bones such as the femur.
The type of acupuncture delivered may matter, and more long-term research is needed to determine the exact effects. But this may be a worthwhile therapy to explore with your medical team if you are interested.
Some research suggests that certain herbs, such asred clover,horsetail,turmeric,and red sagemay have beneficial effects in treating osteoporosis. Notably, most studies examining the benefits are small and short in duration. Some are animal or test tube studies rather than being human studies including people with osteoporosis. Therefore, more research is needed.
The Best Herbs for Osteoporosis
Melatonin is a hormonethat helps regulatecircadian rhythmand is known for its role in sleep. But melatonin may also play a role in bone health.
There is an association between age-related reductions in melatonin with bone loss and osteoporosis.Melatonin may prevent bone degradation, reduce oxidative stress associated with bone loss, and promote bone formation.
Yet, most studies that have been done are in animals or in test tubes. More studies conducted in humans are needed to better understand melatonin’s role in treating osteoporosis. The dosage and timing of supplementation also need to be investigated.
Tai chiis a form of exercise with slow, rhythmic movements. In a 2017 meta-analysis of randomized control trials, researchers found that various forms of long-term tai chi (at least 24 weeks) were effective at reducing bone mineral density loss in certain areas of the body.
Their data included older adults, perimenopausal and postmenopausal people, people with osteoarthritis, and cancer survivors.
The authors note that the type of tai chi, which may differ in impact and use of weight-bearing exercises, as well as the duration of sessions and length of programs, are important factors to consider in examining the data. In addition, the qualifications of the instructor can impact results.
These results are promising and encouraging, however, more research examining these parameters is needed.
Summary
Natural remedies for osteoporosis are plentiful and could be a starting point or an addition to conventional treatment options for osteoporosis. The same concepts used to prevent osteoporosis may help treat it.
Eating a variety of nutrient-dense foods that contain ample amounts of calcium, vitamin D, and other vitamins and minerals is an important first step. In addition, exercise, lifestyle changes such as stopping smoking if you smoke, adding various herbs to your diet, and practicing tai chi may be beneficial. Before starting anything new, discuss it with your medical team.
Frequently Asked QuestionsTraditional treatment options include fall prevention, pain management, diet, exercise, vitamin and mineral supplementation, and medications. Your treatment options should take into account all of the factors of your disease, including your age, how much bone you’ve lost, drug side effects, and your other health conditions.Learn MoreHow Osteoporosis Is TreatedYou can prevent further damage and rebuild bone with natural interventions and certain medications. Individual results will depend on the severity of your disease.Learn MoreThe Truth About Reversing OsteoporosisMost of the nutrients needed for bone health, including bone growth, can be achieved through a diversified diet.Some experts recommend supplementing with vitamin D, calcium, magnesium, and vitamin K, though individual needs differ. Manganese, boron, and zinc also play a role in bone health. Discuss your specific needs with your medical team.Learn MoreAging and Your Bones
Traditional treatment options include fall prevention, pain management, diet, exercise, vitamin and mineral supplementation, and medications. Your treatment options should take into account all of the factors of your disease, including your age, how much bone you’ve lost, drug side effects, and your other health conditions.Learn MoreHow Osteoporosis Is Treated
Traditional treatment options include fall prevention, pain management, diet, exercise, vitamin and mineral supplementation, and medications. Your treatment options should take into account all of the factors of your disease, including your age, how much bone you’ve lost, drug side effects, and your other health conditions.
Learn MoreHow Osteoporosis Is Treated
You can prevent further damage and rebuild bone with natural interventions and certain medications. Individual results will depend on the severity of your disease.Learn MoreThe Truth About Reversing Osteoporosis
You can prevent further damage and rebuild bone with natural interventions and certain medications. Individual results will depend on the severity of your disease.
Learn MoreThe Truth About Reversing Osteoporosis
Most of the nutrients needed for bone health, including bone growth, can be achieved through a diversified diet.Some experts recommend supplementing with vitamin D, calcium, magnesium, and vitamin K, though individual needs differ. Manganese, boron, and zinc also play a role in bone health. Discuss your specific needs with your medical team.Learn MoreAging and Your Bones
Most of the nutrients needed for bone health, including bone growth, can be achieved through a diversified diet.Some experts recommend supplementing with vitamin D, calcium, magnesium, and vitamin K, though individual needs differ. Manganese, boron, and zinc also play a role in bone health. Discuss your specific needs with your medical team.
Learn MoreAging and Your Bones
21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM.A comprehensive overview on osteoporosis and its risk factors.Ther Clin Risk Manag. 2018;14:2029-2049. doi:10.2147/TCRM.S138000International Osteoporosis Foundation.What is osteoporosis?National Institute of Aging.Osteoporosis.Muñoz-Garach A, García-Fontana B, Muñoz-Torres M.Nutrients and dietary patterns related to osteoporosis.Nutrients.2020;12(7):1986. doi:10.3390/nu12071986National Institute of Health. Office of Dietary Supplements.Vitamin D.Webb D.Update on osteoporosis-what you should know about dietary recommendations and the latest therapeutics.Today’s Dietitian.2021; 23(2):4.Barańska A, Kanadys W, Bogdan M, et ak.The role of soy isoflavones in the prevention of bone loss in postmenopausal women: a systematic review with meta-analysis of randomized controlled trials.Journal of Clinical Medicine. 2022; 11(16):4676. doi:10.3390/jcm11164676Harvard T.H. Chan School of Public Health.Straight talk about soy.Chin KY, Ima-Nirwana S.Vitamin C and bone health: evidence from cell, animal and human studies.Curr Drug Targets. 2018;19(5):439-450. doi:10.2174/1389450116666150907100838Tsugawa N, Shiraki M.Vitamin K nutrition and bone health.Nutrients. 2020;12(7):1909. doi:10.3390/nu12071909Bone Health and Osteoporosis Foundation.Nutrition-food and your bones-osteoporosis nutrition guidelines.Chen L, Liu R, Zhao Y, Shi Z.High consumption of soft drinks is associated with an increased risk of fracture: a 7-year follow-up study.Nutrients. 2020;12(2):530. doi:10.3390/nu12020530Harvard Health Publishing.By the way, doctor: Does carbonated water harm bones?National Institute of Arthritis and Musculoskeletal and Skin Disease.Exercise for your bone health.Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P.The effectiveness of acupuncture for osteoporosis: a systematic review and meta-analysis.Am J Chin Med. 2018;46(03):489-513. doi:10.1142/s0192415x18500258Thorup AC, Lambert MN, Kahr HS, Bjerre M, Jeppesen PB.Intake of novel red clover supplementation for 12 weeks improves bone status in healthy menopausal women.Evid Based Complement Alternat Med. 2015;2015:689138. doi:10.1155/2015/689138Arbabzadegan N, Moghadamnia AA, Kazemi S, Nozari F, Moudi E, Haghanifar S.Effect of Equisetum arvense extract on bone mineral density in Wistar rats via digital radiography.Caspian J Intern Med. 2019;10(2):176-182. doi:10.22088/cjim.10.2.176Riva A, Togni S, Giacomelli L, et al.Effects of a curcumin-based supplementation in asymptomatic subjects with low bone density: A preliminary 24-week supplement study.Eur Rev Med Pharmacol Sci. 2017;21(7):1684-1689.Guo Y, Li Y, Xue L, et al.Salvia miltiorrhiza: An ancient Chinese herbal medicine as a source for anti-osteoporotic drugs.J Ethnopharmacol. 2014;155(3):1401-1416. doi:10.1016/j.jep.2014.07.058Li, T, Jiang, S, Lu, C, et al.Melatonin: Another avenue for treating osteoporosis?J Pineal Res. 2019;66:e12548. doi:10.1111/jpi.12548Zou L, Wang C, Chen K, Shu Y, Chen X, Luo L, Zhao X.The effect of taichi practice on attenuating bone mineral density loss: A systematic review and meta-analysis of randomized controlled trials.Int J Environ Res Public Health.2017;14(9):1000. doi:10.3390/ijerph14091000
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM.A comprehensive overview on osteoporosis and its risk factors.Ther Clin Risk Manag. 2018;14:2029-2049. doi:10.2147/TCRM.S138000International Osteoporosis Foundation.What is osteoporosis?National Institute of Aging.Osteoporosis.Muñoz-Garach A, García-Fontana B, Muñoz-Torres M.Nutrients and dietary patterns related to osteoporosis.Nutrients.2020;12(7):1986. doi:10.3390/nu12071986National Institute of Health. Office of Dietary Supplements.Vitamin D.Webb D.Update on osteoporosis-what you should know about dietary recommendations and the latest therapeutics.Today’s Dietitian.2021; 23(2):4.Barańska A, Kanadys W, Bogdan M, et ak.The role of soy isoflavones in the prevention of bone loss in postmenopausal women: a systematic review with meta-analysis of randomized controlled trials.Journal of Clinical Medicine. 2022; 11(16):4676. doi:10.3390/jcm11164676Harvard T.H. Chan School of Public Health.Straight talk about soy.Chin KY, Ima-Nirwana S.Vitamin C and bone health: evidence from cell, animal and human studies.Curr Drug Targets. 2018;19(5):439-450. doi:10.2174/1389450116666150907100838Tsugawa N, Shiraki M.Vitamin K nutrition and bone health.Nutrients. 2020;12(7):1909. doi:10.3390/nu12071909Bone Health and Osteoporosis Foundation.Nutrition-food and your bones-osteoporosis nutrition guidelines.Chen L, Liu R, Zhao Y, Shi Z.High consumption of soft drinks is associated with an increased risk of fracture: a 7-year follow-up study.Nutrients. 2020;12(2):530. doi:10.3390/nu12020530Harvard Health Publishing.By the way, doctor: Does carbonated water harm bones?National Institute of Arthritis and Musculoskeletal and Skin Disease.Exercise for your bone health.Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P.The effectiveness of acupuncture for osteoporosis: a systematic review and meta-analysis.Am J Chin Med. 2018;46(03):489-513. doi:10.1142/s0192415x18500258Thorup AC, Lambert MN, Kahr HS, Bjerre M, Jeppesen PB.Intake of novel red clover supplementation for 12 weeks improves bone status in healthy menopausal women.Evid Based Complement Alternat Med. 2015;2015:689138. doi:10.1155/2015/689138Arbabzadegan N, Moghadamnia AA, Kazemi S, Nozari F, Moudi E, Haghanifar S.Effect of Equisetum arvense extract on bone mineral density in Wistar rats via digital radiography.Caspian J Intern Med. 2019;10(2):176-182. doi:10.22088/cjim.10.2.176Riva A, Togni S, Giacomelli L, et al.Effects of a curcumin-based supplementation in asymptomatic subjects with low bone density: A preliminary 24-week supplement study.Eur Rev Med Pharmacol Sci. 2017;21(7):1684-1689.Guo Y, Li Y, Xue L, et al.Salvia miltiorrhiza: An ancient Chinese herbal medicine as a source for anti-osteoporotic drugs.J Ethnopharmacol. 2014;155(3):1401-1416. doi:10.1016/j.jep.2014.07.058Li, T, Jiang, S, Lu, C, et al.Melatonin: Another avenue for treating osteoporosis?J Pineal Res. 2019;66:e12548. doi:10.1111/jpi.12548Zou L, Wang C, Chen K, Shu Y, Chen X, Luo L, Zhao X.The effect of taichi practice on attenuating bone mineral density loss: A systematic review and meta-analysis of randomized controlled trials.Int J Environ Res Public Health.2017;14(9):1000. doi:10.3390/ijerph14091000
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM.A comprehensive overview on osteoporosis and its risk factors.Ther Clin Risk Manag. 2018;14:2029-2049. doi:10.2147/TCRM.S138000International Osteoporosis Foundation.What is osteoporosis?National Institute of Aging.Osteoporosis.Muñoz-Garach A, García-Fontana B, Muñoz-Torres M.Nutrients and dietary patterns related to osteoporosis.Nutrients.2020;12(7):1986. doi:10.3390/nu12071986National Institute of Health. Office of Dietary Supplements.Vitamin D.Webb D.Update on osteoporosis-what you should know about dietary recommendations and the latest therapeutics.Today’s Dietitian.2021; 23(2):4.Barańska A, Kanadys W, Bogdan M, et ak.The role of soy isoflavones in the prevention of bone loss in postmenopausal women: a systematic review with meta-analysis of randomized controlled trials.Journal of Clinical Medicine. 2022; 11(16):4676. doi:10.3390/jcm11164676Harvard T.H. Chan School of Public Health.Straight talk about soy.Chin KY, Ima-Nirwana S.Vitamin C and bone health: evidence from cell, animal and human studies.Curr Drug Targets. 2018;19(5):439-450. doi:10.2174/1389450116666150907100838Tsugawa N, Shiraki M.Vitamin K nutrition and bone health.Nutrients. 2020;12(7):1909. doi:10.3390/nu12071909Bone Health and Osteoporosis Foundation.Nutrition-food and your bones-osteoporosis nutrition guidelines.Chen L, Liu R, Zhao Y, Shi Z.High consumption of soft drinks is associated with an increased risk of fracture: a 7-year follow-up study.Nutrients. 2020;12(2):530. doi:10.3390/nu12020530Harvard Health Publishing.By the way, doctor: Does carbonated water harm bones?National Institute of Arthritis and Musculoskeletal and Skin Disease.Exercise for your bone health.Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P.The effectiveness of acupuncture for osteoporosis: a systematic review and meta-analysis.Am J Chin Med. 2018;46(03):489-513. doi:10.1142/s0192415x18500258Thorup AC, Lambert MN, Kahr HS, Bjerre M, Jeppesen PB.Intake of novel red clover supplementation for 12 weeks improves bone status in healthy menopausal women.Evid Based Complement Alternat Med. 2015;2015:689138. doi:10.1155/2015/689138Arbabzadegan N, Moghadamnia AA, Kazemi S, Nozari F, Moudi E, Haghanifar S.Effect of Equisetum arvense extract on bone mineral density in Wistar rats via digital radiography.Caspian J Intern Med. 2019;10(2):176-182. doi:10.22088/cjim.10.2.176Riva A, Togni S, Giacomelli L, et al.Effects of a curcumin-based supplementation in asymptomatic subjects with low bone density: A preliminary 24-week supplement study.Eur Rev Med Pharmacol Sci. 2017;21(7):1684-1689.Guo Y, Li Y, Xue L, et al.Salvia miltiorrhiza: An ancient Chinese herbal medicine as a source for anti-osteoporotic drugs.J Ethnopharmacol. 2014;155(3):1401-1416. doi:10.1016/j.jep.2014.07.058Li, T, Jiang, S, Lu, C, et al.Melatonin: Another avenue for treating osteoporosis?J Pineal Res. 2019;66:e12548. doi:10.1111/jpi.12548Zou L, Wang C, Chen K, Shu Y, Chen X, Luo L, Zhao X.The effect of taichi practice on attenuating bone mineral density loss: A systematic review and meta-analysis of randomized controlled trials.Int J Environ Res Public Health.2017;14(9):1000. doi:10.3390/ijerph14091000
Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM.A comprehensive overview on osteoporosis and its risk factors.Ther Clin Risk Manag. 2018;14:2029-2049. doi:10.2147/TCRM.S138000
International Osteoporosis Foundation.What is osteoporosis?
National Institute of Aging.Osteoporosis.
Muñoz-Garach A, García-Fontana B, Muñoz-Torres M.Nutrients and dietary patterns related to osteoporosis.Nutrients.2020;12(7):1986. doi:10.3390/nu12071986
National Institute of Health. Office of Dietary Supplements.Vitamin D.
Webb D.Update on osteoporosis-what you should know about dietary recommendations and the latest therapeutics.Today’s Dietitian.2021; 23(2):4.
Barańska A, Kanadys W, Bogdan M, et ak.The role of soy isoflavones in the prevention of bone loss in postmenopausal women: a systematic review with meta-analysis of randomized controlled trials.Journal of Clinical Medicine. 2022; 11(16):4676. doi:10.3390/jcm11164676
Harvard T.H. Chan School of Public Health.Straight talk about soy.
Chin KY, Ima-Nirwana S.Vitamin C and bone health: evidence from cell, animal and human studies.Curr Drug Targets. 2018;19(5):439-450. doi:10.2174/1389450116666150907100838
Tsugawa N, Shiraki M.Vitamin K nutrition and bone health.Nutrients. 2020;12(7):1909. doi:10.3390/nu12071909
Bone Health and Osteoporosis Foundation.Nutrition-food and your bones-osteoporosis nutrition guidelines.
Chen L, Liu R, Zhao Y, Shi Z.High consumption of soft drinks is associated with an increased risk of fracture: a 7-year follow-up study.Nutrients. 2020;12(2):530. doi:10.3390/nu12020530
Harvard Health Publishing.By the way, doctor: Does carbonated water harm bones?
National Institute of Arthritis and Musculoskeletal and Skin Disease.Exercise for your bone health.
Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P.The effectiveness of acupuncture for osteoporosis: a systematic review and meta-analysis.Am J Chin Med. 2018;46(03):489-513. doi:10.1142/s0192415x18500258
Thorup AC, Lambert MN, Kahr HS, Bjerre M, Jeppesen PB.Intake of novel red clover supplementation for 12 weeks improves bone status in healthy menopausal women.Evid Based Complement Alternat Med. 2015;2015:689138. doi:10.1155/2015/689138
Arbabzadegan N, Moghadamnia AA, Kazemi S, Nozari F, Moudi E, Haghanifar S.Effect of Equisetum arvense extract on bone mineral density in Wistar rats via digital radiography.Caspian J Intern Med. 2019;10(2):176-182. doi:10.22088/cjim.10.2.176
Riva A, Togni S, Giacomelli L, et al.Effects of a curcumin-based supplementation in asymptomatic subjects with low bone density: A preliminary 24-week supplement study.Eur Rev Med Pharmacol Sci. 2017;21(7):1684-1689.
Guo Y, Li Y, Xue L, et al.Salvia miltiorrhiza: An ancient Chinese herbal medicine as a source for anti-osteoporotic drugs.J Ethnopharmacol. 2014;155(3):1401-1416. doi:10.1016/j.jep.2014.07.058
Li, T, Jiang, S, Lu, C, et al.Melatonin: Another avenue for treating osteoporosis?J Pineal Res. 2019;66:e12548. doi:10.1111/jpi.12548
Zou L, Wang C, Chen K, Shu Y, Chen X, Luo L, Zhao X.The effect of taichi practice on attenuating bone mineral density loss: A systematic review and meta-analysis of randomized controlled trials.Int J Environ Res Public Health.2017;14(9):1000. doi:10.3390/ijerph14091000
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