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骨骼健康与骨质疏松症

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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
骨小梁的横截面，显示其蜂窝状内部结构。
骨骼是活组织；其内部的蜂窝状结构会随年龄增长和骨质疏松而变薄，从而增加骨折风险。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会注意到肩部疼痛，且在活动时加重。将手伸到背后扣文胸可能会变得困难。将衬衫塞进裤子里也可能感觉别扭或疼痛。不适感常在夜间加剧，导致难以在患侧侧卧入睡。即使您骨矿物质密度降低（这是骨骼变弱的迹象），这种情况也很常见。

尽管存在这些症状，许多患者在关节镜下肩袖修复术后两年仍能取得良好的效果。该手术使用小型摄像头和器械来修复肩部撕裂的肌腱。您的外科医生将评估您的具体情况，以确定最佳治疗方案。骨质疏松症不应阻止您接受此手术，因为总体并发症率仍然较低。然而，患有骨质疏松症意味着您在修复术后一到三年内面临更高的并发症和再次手术风险。

请注意，与骨骼健康者相比，骨质疏松症患者在接受肩袖手术后前90天内可能面临更高的医疗问题发生率。与您的护理团队讨论您的骨骼健康状况非常重要。即使在指南推荐治疗的情况下，股骨颈骨折患者中骨质疏松症药物治疗的使用率也很低。现在解决您的骨密度问题有助于支持您的康复和长期肩部功能。

实际发生了什么

骨质疏松症意味着您的骨骼变得脆弱且易碎。可以将健康的骨骼想象成一个致密的蜂窝。在骨质疏松症中，蜂窝中的孔洞会变大。这使得结构变得脆性增加，更容易发生骨折。在骨折发生之前，您可能不会感到任何疼痛。然而，骨骼脆弱也会影响术后关节的愈合情况。

例如，如果您接受肩部手术，骨质疏松症是术后1年和3年出现并发症和再次手术的风险因素。这是因为骨骼需要足够坚固以固定修复部位。尽管存在这种风险，但骨质疏松症不应被视为避免关节镜下肩袖修复术的理由。总体并发症发生率较低。事实上，骨密度降低的患者在该手术后仍可获得良好的2年预后。

重要的是要知道，骨质疏松症会增加您出现其他问题的风险。与无骨质疏松症的患者相比，接受肩袖修复术的骨质疏松症患者在术后90天全球期内的医疗并发症发生率更高。这意味着您在术后前三个月需要密切监测。

您的外科医生可能会采用特定的技术来支持您的愈合。对于脊柱手术，持续骨水泥和标准化治疗是经皮椎体成形术良好临床结果的保证。注射骨水泥体积大于5.5毫升可能是经皮椎体成形术良好临床结果的保证。这些步骤有助于稳定骨骼并减轻疼痛。

此外，还有许多管理骨骼健康的方法。天然中药产品为新药开发和骨质疏松症管理的改善提供了理论和实验基础。针灸作为临床实践中的物理干预措施，在改善原发性骨质疏松症症状方面显示出令人鼓舞的疗效。此外，优化特立帕肽的给药时间可能指导个体化给药策略，以增强骨形成并降低骨质疏松症的骨折风险。

您的医疗团队正在努力保持您的骨骼强健。基于骨密度的衰老模型可能促进和支持骨质疏松症预防和管理的精准医疗策略的发展。这有助于根据您的具体需求定制治疗方案。序贯促骨形成-抗骨吸收治疗可能为高风险绝经后人群的治疗指南提供依据。这些方法旨在促进新骨生成并防止其过快分解。

预期情况

您的预后很大程度上取决于您和您的外科医生对骨骼健康的积极管理程度。骨质疏松症是一种骨骼变得脆弱和易碎的疾病。通过现代医疗手段，这并非注定走向衰退的判决。新的方法，例如利用骨密度扫描来定制您的治疗方案，有助于您的外科医生为您制定个性化的计划。这种个性化策略旨在增强您的骨骼强度并降低骨折风险。

如果您接受治疗，目标是重建骨骼强度。您的外科医生可能会推荐特定的药物或疗法，以促进新骨生成。一些患者还通过针灸等物理干预措施获得缓解，这有助于减轻疼痛并提高日常舒适度。关键在于坚持。当治疗得到妥善管理时——例如在脊柱手术中使用适量的骨水泥——您可以期待稳定且积极的结果，从而支持您的活动能力和生活质量。

如果骨质疏松症未得到管理，风险将显著增加。脆弱的骨骼更容易发生骨折，这可能导致严重的并发症。例如，骨质疏松症患者在接受其他手术（如肩袖修复术）后的三个月内，面临更高几率出现其他医疗问题。然而，患有骨质疏松症并不意味着您不能接受手术。许多患者在肩袖修复术等手术两年后，即使骨密度较低，仍能取得良好的预后。主要要点是，骨质疏松症是一个风险因素，而非障碍。它需要仔细关注，以预防术后一年和三年时的并发症和再次手术。

每个人的康复感受各不相同。有些日子可能会比其他日子更容易度过。未来的道路涉及密切监测您的骨骼健康并坚持您的治疗方案。通过保持积极主动，您为自己维持力量和独立性提供了最佳机会。您的外科医生将指导您完成每一步，确保您的护理随着您的需求变化而调整。

Reviewed by Kieran Hirpara · 13 June 2026.

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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.