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Kalusugan ng Buto at Osteoporosis

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How bone strength affects fractures, fixation and recovery — bone density, fragility fractures, and what helps keep bones strong (lifestyle, supplements and medications).

Updated Aug 2026
Krus-aksyon ng trabekular na buto na nagpapakita ng honeycomb na internal na istruktura nito.
Ang buto ay buhay na tisyu; ang internal na honeycomb nito ay nagiging manipis sa pagtanda at sa osteoporosis, na nagpapataas ng panganib ng fracture. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mapansin mo ang sakit sa iyong balikat na lumalala kapag gumagalaw. Mahirap na umabot sa likod ng iyong likod upang isara ang bra. Ang pagtatakip ng isang kamiseta ay maaari ring maging nakakahiya o nakakairita. Karaniwang lumala ang hindi komportableng pakiramdam sa gabi, na nagpapatigil sa pagtulog sa apektadong gilid. Ito ay karaniwan kahit mayroon kang baba ng mineral density ng buto, na isang senyales ng mahinang mga buto.

Sa kabila ng mga sintomas na ito, maraming pasyente pa rin ang nakakamit ng mahusay na resulta dalawang taon pagkatapos ng arthroscopic rotator cuff repair. Ang prosedurang ito ay gumagamit ng maliit na mga kamera at instrumento upang ayusin ang mga naputol na tendon sa balikat. Ang iyong surgeon ay mag-evaluate ng iyong partikular na sitwasyon upang matukoy ang pinakamainam na paraan. Ang osteoporosis ay hindi dapat humadlang sa iyo na magsagawa ng operasyong ito, dahil ang kabuuang rate ng komplikasyon ay nananatiling mababa. Gayunpaman, ang pagkakaroon ng osteoporosis ay nangangahulugan na ikaw ay nasa mas mataas na panganib para sa mga komplikasyon at reoperations isang hanggang tatlong taon pagkatapos ng repair.

Magkaroon ng kamalayan na ang mga pasyente na may osteoporosis ay maaaring harapin ang mas mataas na pagkakataon ng mga medical issues sa loob ng unang 90 araw pagkatapos ng rotator cuff surgery kumpara sa mga may malusog na mga buto. Mahalagang talakayin ang iyong kalusugan ng buto sa iyong care team. Mababang rate ng paggamit ng gamot para sa osteoporosis ay nakikita sa mga pasyente na nakaranas ng femoral neck fractures, kahit na ang mga gabay ay nagre-rekomenda ng treatment. Ang pag-aaddress ng iyong bone density ngayon ay makakatulong upang suportahan ang iyong recovery at long-term shoulder function.

Ano ang nangyayari talaga

Ang osteoporosis ay nangangahulugan na ang iyong mga buto ay naging mahina at madaling maputol. Isipin ang malusog na buto na parang isang siksik na honeycomb. Sa osteoporosis, lumalaki ang mga butas sa honeycomb na iyon. Ginagawa nitong mas mabali ang istruktura at mas malamang na maputol. Maaaring hindi mararamdaman ang anumang sakit hanggang sa mangyari ang fracture. Gayunpaman, ang mga mahinang buto ay maaari ring makaapekto sa paggaling ng iyong mga kasu-kasuan pagkatapos ng operasyon.

Halimbawa, kung mayroon kang shoulder surgery, ang osteoporosis ay isang risk factor para sa mga komplikasyon at reoperations sa 1 at 3 taon. Ito ay dahil kailangang sapat na matibay ang buto upang hawakan ang repair sa tamang posisyon. Sa kabila ng risk na ito, hindi dapat ituring ang osteoporosis na dahilan upang iwasan ang arthroscopic rotator cuff repair. Mababa ang kabuuang rates ng komplikasyon. Sa katunayan, ang mga pasyente na may babaang bone density ay maaari pa ring makamit ang mahusay na 2-year outcomes pagkatapos ng prosedurang ito.

Mahalagang malaman na ang osteoporosis ay maaaring magpataas ng iyong risk para sa ibang mga isyu. Ang mga pasyente na may osteoporosis ay maaaring maranasan ang mas mataas na incidence ng mga medical complications sa loob ng 90-day global period kumpara sa mga nonosteoporotic patients pagkatapos ng rotator cuff repair. Ibig sabihin, kailangan mo ng maingat na monitoring sa unang tatlong buwan pagkatapos ng operasyon.

Maaaring gumamit ang iyong surgeon ng mga partikular na teknik upang suportahan ang iyong paggaling. Para sa mga spine procedures, ang continuous bone cement at standardized treatment ay mga guarantee ng magandang clinical outcomes para sa percutaneous vertebroplasty. Ang injected bone cement volume na higit sa 5.5 ml ay maaaring maging guarantee ng magandang clinical outcomes para sa percutaneous vertebroplasty. Ang mga hakbang na ito ay tumutulong na istabilisa ang buto at bawasan ang sakit.

Mayroon ding maraming paraan upang pamahalaan ang kalusugan ng buto. Ang mga natural na tradisyonal na Chinese medicine products ay nagbibigay ng teoretikal at eksperimental na batayan para sa pagpapaunlad ng mga bagong gamot at pagpapabuti ng pamamahala ng osteoporosis. Ang acupuncture ay nagpapakita ng nakaka-engganyong efficacy sa pagpapabuti ng mga sintomas ng primary osteoporosis bilang isang physical intervention sa clinical practice. Bukod dito, ang pag-optimize ng timing ng pagbibigay ng teriparatide ay maaaring gabayan ang mga personalized na dosing strategies upang palakasin ang bone formation at bawasan ang risk ng fracture sa osteoporosis.

Ang iyong care team ay nagtatrabaho upang panatilihing matibay ang iyong mga buto. Ang isang bone density-based aging model ay maaaring magpasimple at suportahan ang pagpapaunlad ng mga precision medicine strategies sa osteoporosis prevention at management. Tumutulong ito upang i-tailor ang iyong treatment sa iyong mga partikular na pangangailangan. Ang sequential anabolic-to-anti-resorptive therapy ay maaaring magbigay-daan sa mga treatment guidelines para sa mga high-risk postmenopausal populations. Layunin ng mga pamamaraang ito na bumuo ng bagong buto at pigilan itong mabilis na mabasag.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende sa malaking bahagi sa kung gaano ka-aktibo ang iyong pagpapamahala ng kalusugan ng buto kasama ang iyong doktor. Ang osteoporosis ay isang kondisyon kung saan ang mga buto ay nagiging mahina at madaling maputol. Sa pamamagitan ng makabagong pag-aalaga, hindi ito isang parusa sa hindi maiiwasang pagbaba. Ang mga bagong paraan, tulad ng paggamit ng mga scan ng densidad ng buto upang i-customize ang iyong paggamot, ay tumutulong sa iyong doktor na lumikha ng plano na para lamang sa iyo. Ang personalisadong estratehiyang ito ay naglalayong palakasin ang iyong mga buto at bawasan ang iyong risk ng pagkabali.

Kung tatanggapin mo ang paggamot, ang layunin ay muling magtayo ng lakas. Maaaring irekomenda ng iyong doktor ang mga partikular na gamot o terapiya na nagpapalago ng bagong buto. May ilang pasyente rin ang nakakahanap ng ginhawa sa pamamagitan ng mga pisikal na interbensyon tulad ng acupuncture, na maaaring tumulong upang bawasan ang sakit at mapabuti ang pang-araw-araw na kaginhawaan. Ang susi ay ang konsistensya. Kapag ang paggamot ay maayos na pinamamahalaan—tulad ng paggamit ng tamang dami ng bone cement para sa mga spinal na prosedura—maaari kang mag-expect ng matatag at positibong resulta na sumusuporta sa iyong mobility at kalidad ng buhay.

Kung hindi pamahalaan ang osteoporosis, ang mga risk ay malaki ang pagtaas. Ang mga mahinang buto ay mas madaling makaranas ng fractures, na maaaring magdulot ng seryosong komplikasyon. Halimbawa, ang mga pasyente na may osteoporosis ay madalas na nakaharap sa mas mataas na tsansa ng mga medical na isyu sa loob ng tatlong buwan pagkatapos ng ibang mga operasyon, tulad ng rotator cuff repair. Gayunpaman, ang pagkakaroon ng osteoporosis ay hindi nangangahulugan na hindi ka makakapagkaroon ng operasyon. Maraming pasyente pa rin ang nakakamit ng mahusay na resulta dalawang taon pagkatapos ng mga operasyon tulad ng rotator cuff repair, kahit na may mas mababang densidad ng buto. Ang pangunahing aral ay ang osteoporosis ay isang risk factor, hindi hadlang. Ito ay nangangailangan ng maingat na pag-iingat upang maiwasan ang mga komplikasyon at reoperations sa isang at tatlong taon pagkatapos ng operasyon.

Ang paggaling ay magkaiba-iba sa bawat isa. May mga araw na mas madali kaysa sa iba. Ang daan papunta ay kinakailangan ng malapitang pagmamasid sa iyong kalusugan ng buto at pagsunod sa iyong plano ng paggamot. Sa pamamagitan ng pagiging proactive, ibinibigay mo sa sarili mo ang pinakamataas na tsansa upang mapanatili ang lakas at kalayaan. Ang iyong doktor ang gabay sa iyo sa bawat hakbang, tinitiyak na ang iyong pag-aalaga ay magbubago ayon sa pagbabago ng iyong mga pangangailangan.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • A bone density based aging model may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management [1].
  • Optimizing teriparatide administration timing may guide personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis [2].
  • Natural traditional Chinese medicine products provide a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management [3].
  • Sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations [4].
  • Acupuncture shows encouraging efficacy in improving symptoms of primary osteoporosis as a physical intervention in clinical practice [5].
  • Machine learning application to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6].
  • Low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures despite established guidelines [7].
  • Patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patients following rotator cuff repair [8].
  • Patients with decreased bone mineral density can still achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9].
  • Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after arthroscopic rotator cuff repair [11].
  • Osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair given overall low complication rates [11].
  • Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for percutaneous vertebroplasty [12].
  • Injected bone cement >5.5 ml might be a guarantee of good clinical outcomes for percutaneous vertebroplasty [12].

How It Works

  • Bone density-based aging models can facilitate and support the development of precision medicine strategies in osteoporosis prevention and management [1].
  • Acupuncture shows encouraging efficacy in improving symptoms of primary osteoporosis, supporting its use as a physical intervention in clinical practice [5].
  • Machine learning applied to hand radiographs represents a possible step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6].
  • Low rates of osteoporotic pharmacotherapy are observed in patients who have sustained femoral neck fractures despite established guidelines [7].
  • Patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period following rotator cuff repair than nonosteoporotic patients [8].
  • Patients with decreased bone mineral density can still achieve excellent 2-year outcomes following arthroscopic rotator cuff repair [9].
  • Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are generally characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility [10].
  • Genetically modified stem cell therapy is a safe and effective method that can significantly improve bone mineral density and bone volume/total volume in animal models of osteoporosis [13].
  • The prevalence of osteoporosis among postmenopausal women hospitalized for fractures in China is 76.9%, with prolonged menopause, vertebral fractures, and recent fracture history identified as key risk profiles [14].
  • Obesity-associated dyslipidemia drives bone mineral density loss partly through inflammation-mediated pathways, with key inflammatory cytokines significantly mediating lipid metabolism's impact on bone health [16].
  • Bone mineral density alone cannot predict early migration of tibial baseplates in cementless total knee arthroplasty [17].

What the Evidence Shows

Risk Prediction and Screening

  • A bone density-based aging model may facilitate precision medicine strategies in osteoporosis prevention and management [1].

Pharmacologic and Non-Pharmacologic Therapies

  • The efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention [5].
  • Genetically modified stem cell therapy is a safe and effective method that can significantly improve bone mineral density (BMD) and bone volume/total volume (BV/TV) in animal models of osteoporosis [13].
  • Jintiange capsules are a good choice for patients with osteoporosis for relieving pain, improving BMD, improving activity function, and improving gait and preventing fracture [18].

Perioperative Outcomes and Complications

  • Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures [7].
  • In osteopenic and osteoporotic patients undergoing total joint arthroplasty, rates of 2- and 5-year postoperative complications were low and similar among patients who used proton pump inhibitors perioperatively and those who did not [15].
  • Bisphosphonate use in patients who have osteoporosis did not decrease the risk of periprosthetic fracture following total knee arthroplasty, but significantly lowered the incidence of all-cause revision at 2 years [20].

Surgical Efficacy and Technical Factors

  • Osteoporosis should not be considered a contraindication to arthroscopic rotator cuff repair [11].
  • Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for percutaneous vertebroplasty, and injected bone cement >5.5 ml might be a guarantee [12].

Practical Considerations

  • Bone density-based aging models may facilitate precision medicine strategies in osteoporosis prevention and management [1].
  • Machine learning applied to hand radiographs represents a step toward more accessible, cost-effective, automated diagnosis and earlier treatment of osteoporosis/osteopenia [6].
  • Low rates of osteoporotic pharmacotherapy were observed in patients with femoral neck fractures despite established guidelines [7].
  • Patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period following rotator cuff repair compared to nonosteoporotic patients [8].
  • Patients with decreased bone mineral density can achieve excellent 2-year outcomes after arthroscopic rotator cuff repair [9].
  • Machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility [10].
  • Continuous bone cement and standardized treatment for osteoporosis are guarantees of good clinical outcomes for percutaneous vertebroplasty [12].
  • Injected bone cement volume greater than 5.5 ml might be a guarantee of good clinical outcomes for percutaneous vertebroplasty [12].
  • The prevalence of osteoporosis among postmenopausal women hospitalized for fractures in China is 76.9% [14].
  • Prolonged menopause, vertebral fractures, and recent fracture history are key risk profiles for osteoporosis in postmenopausal women hospitalized for fractures [14].
  • Rates of 2- and 5-year postoperative complications in osteopenic and osteoporotic patients undergoing total joint arthroplasty were low and similar among those who used perioperative proton pump inhibitors and those who did not [15].

Key Evidence

  • [L3] This approach may facilitate and support the development of precision medicine strategies in osteoporosis prevention and management. [1] (10.1186/s12891-025-09298-0)
  • [L2] This trial is expected to provide crucial insights into optimizing teriparatide administration timing, potentially guiding personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis. [2] (10.1186/s13018-025-06083-6)
  • [L4] This paper summarises recent research progress on natural TCM products in preventing and treating osteoporosis and provides a theoretical and experimental basis for the development of new drugs and the improvement of osteoporosis management. [3] (10.1186/s13018-025-05879-w)
  • [L1] This sequential anabolic-to-anti-resorptive therapy may inform treatment guidelines for high-risk postmenopausal populations. [4] (10.1186/s13018-025-06040-3)
  • [L1] The current evidence suggests that the efficacy of acupuncture in improving the symptoms of primary osteoporosis is encouraging for its use in clinical practice as a physical intervention. [5] (10.1186/s13018-025-05513-9)
  • [L2] The findings represent a possible step toward more accessible, cost-effective, automated diagnosis and therefore earlier treatment of osteoporosis/osteopenia. [6] (10.1016/j.jhsa.2024.09.008)
  • [L3] Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures. [7] (10.1016/j.arth.2025.07.028)
  • [L3] In addition, patients with osteoporosis may experience a higher incidence of medical complications within the 90-day global period than nonosteoporotic patient. [8] (10.1016/j.xrrt.2026.100723)
  • [L3] Patients with decreased bone mineral density can still achieve excellent 2-year outcomes. [9] (10.1016/j.jse.2025.02.011)
  • [L1] Current machine learning-based prediction models for postmenopausal osteoporosis without fractures demonstrate good discriminative ability but are generally characterized by a high risk of bias, a notable lack of calibration performance evaluation, and insufficient validation of clinical utility. [10] (10.1186/s12891-025-09385-2)
  • [L3] Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic RCR. [11] (10.1016/j.jseint.2026.101678)
  • [L3] Continuous bone cement and standardized treatment for osteoporosis were guarantees of good clinical outcomes for PVP, and injected bone cement >5.5 ml might be a guarantee. [12] (10.1186/s12891-024-08153-y)
  • [L1] Genetically modified stem cell therapy is a safe and effective method that can significantly improve the BMD and BV/TV in animal models of osteoporosis. [13] (10.1186/s12891-025-08507-0)
  • [L4] This study reveals an alarmingly high prevalence (76.9%) of osteoporosis among postmenopausal women hospitalized for fractures in China, identifying prolonged menopause, vertebral fractures, and recent fracture history as key risk profiles. [14] (10.1186/s12891-026-09517-2)
  • [L3] In osteopenic and osteoporotic patients undergoing TJA, rates of 2- and 5-year postoperative complications were low and similar among patients who used PPIs perioperatively and those who did not. [15] (10.1016/j.arth.2025.07.067)
  • [L4] Obesity-associated dyslipidemia drives BMD loss partly through inflammation-mediated pathways, with key inflammatory cytokines significantly mediating lipid metabolism's impact on bone health. [16] (10.1186/s12891-026-09576-5)
  • [L4] Our results suggest that BMD alone cannot predict early migration of tibial baseplates. [17] (10.1016/j.arth.2026.03.014)
  • [L1] In terms of relieving pain, improving BMD, improving activity function, and improving gait and preventing fracture, JTG is a good choice for patients with osteoporosis (OP). [18] (10.1186/s12891-025-08694-w)
  • [L3] While bisphosphonate use in patients who have osteoporosis did not decrease the risk of periprosthetic fracture, it did significantly lower the incidence of all-cause revision at 2 years. [20] (10.1016/j.arth.2024.11.004)

References

[1] Unveiling risk factors and predicting osteoporosis through bone density based aging model: a community-based cohort in Guangdong, China. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09298-0

[2] Timing optimization of teriparatide dosing for postmenopausal osteoporosis: a randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06083-6

[3] Natural traditional Chinese medicine products: emerging therapeutic targets for the treatment of osteoporosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05879-w

[4] Effectiveness of anabolic and anti-resorptive agents for preventing postmenopausal osteoporosis fractures: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06040-3

[5] Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05513-9

[6] Application of Machine Learning to Osteoporosis and Osteopenia Screening Using Hand Radiographs. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.008

[7] A Missed Opportunity? Osteoporosis Treatment Following Femoral Neck Fractures: Reducing the Risk of Secondary Hip Fracture. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.028

[8] Impact of osteoporosis on post-operative outcomes following rotator cuff repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100723

[9] No difference in 2-year outcomes of arthroscopic rotator cuff repair in patients with osteoporosis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.011

[10] Risk prediction models for postmenopausal osteoporosis: a systematic review and meta-analysis study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-09385-2

[11] Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after arthroscopic rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101678

[12] Continuity and volume of bone cement and anti osteoporosis treatment were guarantee of good clinical outcomes for percutaneous vertebroplasty: a multicenter study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08153-y

[13] Genetically modified stem cells for osteoporosis: a systematic review and meta-analysis of preclinical studies. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08507-0

[14] How prevalent is osteoporosis in a high-risk subgroup? A multicenter study of postmenopausal women hospitalized for fractures in China. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09517-2

[15] Effects of Perioperative Proton Pump Inhibitor Use on Outcomes of Total Joint Arthroplasty Patients Who Have Osteoporosis and Osteopenia. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.067

[16] Perioperative inflammatory cytokines nursing screening test indicate the link between dysregulated lipid metabolism and reduced bone mineral density in obese osteoporosis patients: a retrospective study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09576-5

[17] Stable Fixation in Cementless Total Knee Arthroplasty Even for Low Local Bone Mineral Density. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.014

[18] The effect of Jintiange capsules on pain in patients with primary osteoporosis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08694-w

[20] Bisphosphonate Use in Patients Who Have Osteoporosis Does Not Increase the Risk of Periprosthetic Fracture Following Total Knee Arthroplasty. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.11.004

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a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.