By Shihan Mary Bolz, L. Ac., M. Sc.
Over twenty-four million people in the U. S. suffer from osteoporosis, literally, a condition of “porous bones.” “Osteo” refers to bones and “porosis” refers to porous.
It is characterized by decreased bone mass and increased susceptibility to fractures. The basic problem is that bone resorption outpaces bone formation. The disorder primarily affects middle-aged and elderly people-women more than men and white more than blacks. But osteoporosis may occur in both men and women. If men do develop osteoporosis, it can be severe. Between puberty and mid-life, sex hormones (several types of estrogens in women and testosterone in men) and other hormones maintain bone tissue by stimulating the osteoblasts to form new bone. After menopause, women produce much smaller amounts of estrogen, and both men and women produce smaller amounts of the sex hormones as they age. As a result, the osteoblasts (the cells which stimulate the production of bone tissue) become less active and there is a decrease in bone mass.
The term osteopenia (osteo=bone, penia=poverty ) means a reduced bone mass due to a decrease in the rate of bone synthesis to a level insufficient to compensate for normal bone breakdown; any decrease in bone mass below normal. An example of osteopenia is osteoporosis. Osteomalacia is a condition meaning the softening of bone and is thought to be caused by a deficiency of vitamin D in adults causing demineralization and softening of bone. Vitamin D is essential for absorption and utilization of calcium and phosphorus from the gastrointestinal tract. It may work with parathyroid hormone (PTH) that controls calcium metabolism.
Although most common in women over age 50, osteoporosis can also occur in female runners and ballet dancers, male marathoners whose caloric intake is inadequate, teenagers on junk-food diets, young women suffering from eating disorders, nursing mothers, and in those exposed to prolonged treatment with cortisone or high levels of thyroid hormones. Often, the first symptoms of osteoporosis is pathological fracture. Bone mass becomes so depleted that the skeleton can no longer withstand the mechanical stresses of everyday living. For example, a hip fracture might result from sitting down too quickly. Osteoporosis causes more than 250,000 hip fractures and 500,000 spinal fractures a year and complications from osteoporosis are the 12th leading cause of death in the U. S. It is responsible for shrinkage of the vertebrae and height loss, hunched backs, bone fractures and considerable pain. Osteoporosis afflicts the entire skeletal system.
Some of the risk factors for developing osteoporosis are (1) smoking, (smoking decreases blood estrogen levels), (2) calcium deficiency and malabsorption, (3) vitamin D deficiency (4) lack of exercise (sedentary people are more likely to develop bone loss), (5) certain drugs (alcohol, some diuretics, cortisone, and tetracycline promote bone loss), (6) premature menopause (7) a family history of osteoporosis (8) those who over-exercise or are overly thin since adipose tissue is a source of estrone, an estrogen that retards bone loss, and importantly (9) a bodily acid-base balance that is more acidic due to consumption of sugar, salt, excessive protein, carbonated soft drinks, caffeine, and processed foods. In fact, the modern peoples’ bodies being more acidic is a cause of many of the diseases we have today. Another risk factor may include use of broad spectrum antibiotics and as stated previously, the glucocorticoid medications, such as Prednisone, fluoride, and excess thyroxin.
The important mainstays for preventing osteoporosis are diet and exercise and maintaining the proper hormone balance in post menopausal women. Adequate diet and exercise in the early years are more beneficial to a woman then calcium supplements when she is older in terms of prevention.
Let’s take a closer look at what this means. Everybody touts exercise and diet, but what really is the benefit? First and foremost, do not underestimate the role of exercise in bone formation. Bone has the ability to alter its strength in response to mechanical stress. When placed under mechanical stress, bone tissue becomes stronger through increased deposition of mineral salts and production of collagen fibers. Another effect of stress is to increase the production of calcitonon, which inhibits bone resorption. Without mechanical stress, bone does not remodel normally, since resorption outstrips bone formation. Removal of mechanical stress weakens bone through demineralization (loss of bone minerals) and collagen reduction. The main mechanical stress on bone are those that result from the pull of skeletal muscles and the pull of gravity. This has been shown when astronauts subjected to the weightlessness of space also lose bone mass, as well as bedridden patients and those with a fractured bone in a cast. In all cases, the bone loss can be dramatic, as much as 1% per week. Bones of athletes, which are repetitively and highly stressed, become notably thicker than those of nonathletes. The mechanical stress of exercise stimulates the positive and negative ions in the blood and body fluids and the osteoblasts (cells which build the bone tissue) are stimulated into production. The increased activity enhances calcification, vascularization and endochondral ossification, accelerating repair of bone. One theory prevalent is that bone behaves as a piezoelectric crystal that converts mechanical energy into electrical energy. The electrical charges that are created when bone is mechanically stressed stimulate the activity of the osteoblasts (bone-forming cells) which leads to a buildup of calcium. The quantity of bone buildup depends on both the magnitude of the force as well as its frequency of application. Chemical factors, as previously stated, produced in bone itself may also contribute to bone formation.
There is one form of electrotherapy used to stimulate bone repair in patients with a fracture. Fracture sites can be exposed to a weak electrical current generated from coils that are fastened around the cast. Osteoblasts adjacent to the fracture site become more active metabolically in response to the stimulation. One hypothesis suggests that electricity also heals fractures by keeping PTH (parathyroid hormone) from acting on osteoclasts, thus increasing bone formation and repair. Could this be a case for electroacupuncture from a scientific standpoint, other than its current function? Possibly.
There have been clinical trials done many times and in different universities that have shown exercise as one of, if not, the number one factor in prevention of this disease. One clinical trial was done with a group of persons with known osteopenia in the age group of 70-90 years old. Three groups were involved: a group who took calcium supplements and did not exercise, a group who took calcium supplements and exercised, and a group who only exercised, without any particular calcium supplementation. No change in diet for any of the groups. It turned out that the group that took only calcium supplements and did not exercise actually had additional bone loss. The group that exercised only and the group that exercised and took calcium supplements both had an additional percentage increase in bone mass in each subject. This is another example of the case that it is lack of exercise affecting Americans more than insufficient calcium intake. The average American diet, if not absolutely a junk-food diet, is not that inadequate in calcium but the lifestyle of those with this disease usually demonstrates a deficiency of exercise. There are always exceptions to this, of course.
Treatment for osteoporosis by allopathic (Western) medicine has consisted of calcium supplementation, pharmaceutical agents to minimize further bone loss, and in post menopausal women, estrogen supplements for severe osteoporosis. But estrogen therapy must be continued for prolonged periods, thus increasing the risk for cancers of the uterus, breast and other organs. Thus, hormone treatment for osteoporosis is often viewed as a more dramatic approach. Treatment with growth factors and parathyroid hormone have been under investigation. Short term androgen (male hormone) administration is used in women with severe, uncontrolled fractures. The allopathic (Western) medical prevention of osteoporosis consists of maintaining adequate body weight, increased walking and weight-bearing exercise, avoidance of long-acting benzodiazepines, minimal caffeine and alcohol intake, and decreased smoking.
What does Oriental medicine have to say about this disease and how is it treated?
The causes of osteoporosis are looked at as congenital insufficiency, aging, unregulated eating and drinking, unregulated exercise, either too much or too little weight-bearing exercise. The reason different people are prone to it are as different as each individual, but one basic concept of the disease mechanism is kidney insufficiency. The kidneys rule the bones and generate both the bones and the marrow. When the kidneys are normal and healthy, the marrow is replete and the bones are strong. The lumbus is the mansion of the kidneys and the upper back is reached by the pathway of the kidneys. Therefore, osteoporosis is mainly due to vacuity decline of the kidneys, both yin and yang. Kidney yang deficiency often evolves out of spleen energy deficiency, while liver blood-kidney yin deficiency is due to the aging process, enduring heat, or habitual imbalance of the bodies’ energy system. For example, alcohol damages the spleen and generates damp heat within the body while cigarette- smoking damages the lungs and consumes the fluids in the body, affecting the kidneys. Indeed, when a patient is seen by a doctor of Oriental medicine, often the pulses, tongue and other diagnostic manifestations of the body indicate an imbalance and/or deficiency of the kidneys. This is not to say other factors are not involved. Other organs and malfunctions must be looked at as well. These are some generalized tendencies. When this is the case, acupuncture and herbal prescription will be geared toward supplementing the kidneys, boosting the marrow and strengthening the bones. Acupuncture can provide relief from the pain, increase the body’s own strength and healing, and improve circulation of all nutrients, fluids, and energy to build the bone. The ability of acupuncture to stimulate these functions should not be underestimated.
In the Chinese herbal prescription, it will depend on the individual’s underlying pattern and also the location of the bone loss. A good herbal formula will address the patient’s entire need. In the case of perimenopausal, menopausal, or post menopausal women, a formula will address the hormonal needs in addition to the general underlying cause. This is not because the herb(s) have an estrogenic effect, but what it/they can do as far as balancing all the bodily functions so that the correct amount of hormones and all other constituents that are needed can be obtained.
Dang gui is an herb that is used often in many formulas for this condition. Dang gui root is sweet, pungent and warm, goes into the liver, heart and spleen and its major action is to nourish the blood, invigorate blood circulation and used as emollient and laxative. It is used for multiple conditions, such as anemia, abdominal pain, dysmenorrhea, amenorrhea, other menstrual disorders, traumatic injury, arthritis, coronary heart disease, angina pectoris, constipation of the aged and debilitated. It’s pharmacological action on the uterus is excitatory and inhibitory, prevents the decrease of liver glycogen and protects the liver, prevents deficiency of vitamin E., anit-pernicious anemia, lowers blood cholesterol, increases the flow of blood to the coronary artery and prevents myocardial ischemia, antibacterial, sedative, analgesic, anti-inflammatory, has action similar to quinidine, (has therapeutic effect on auricular fibrillation), but there is no direct female sex hormone action. However, dang gui is so effective at regulating hormonal imbalance that it will often completely relieve hot flashes and other symptoms of menopause, as well as improving muscle pain and bone loss. When included in the correct formula, it acts like it has a female sex hormone action as far as obtained results. It is not understood scientifically how it works, there is just centuries of empirical evidence. It is included in many women’s Chinese herbal formulas related to gynecological problems. In China, women commonly use dang gui as a food, putting the root into soup. The root is very hard in the dried state, and the same root can be made into an herbal decoction several times by cooking in water for half an hour. When the root becomes entirely soft, it is customarily eaten as a vegetable with rice.
The herb gu sui bu (drymania fortunei, rhizoma drynari) has been used for centuries in formulas to connect the bone tissue, promotes the mending of the sinews and bones, invigorate the circulation of blood and nourish the liver and kidney. it stimulates the production of bone cells. Interestingly, gu sui bu, directly translated from Chinese means “mender of shattered bones.” Bu gu zhi ( fructus psoralae corylifoliae) may also be one of the herbs included, it literally translates as “tonify bone resin.” It works mainly by supplementing the kidneys, fortifies the yang, and the spleen.
These are just a couple of examples of the way some herbs work in Oriental medicine. The main point is, Oriental herbal medicine works by getting the body to function properly itself, not by artificial or superficial means, in all of its modalities, including acupuncture. A person can not just go out and make their own formulas by themselves, though. This should be done by a qualified Oriental herbal medicine practitioner.
The main things each individual can do for themselves is to exercise regularly, neither too much nor too little, it must be weight-bearing exercise, and forget all those “wonderful” vices of caffeine, alcohol, junk food, etc. Also realize that the best way to get all needed nutrients are through a balanced diet and know the myriad sources of calcium besides dairy products. Dairy products are not that high in calcium compared to many vegetarian sources. The cost of dairy as a calcium source is unwanted effects, such as producing phlegm, weakening the spleen function, unwanted saturated fat, and even antibiotics and hormones if the dairy products are not organic.
Remember, all things can be turned around. How about one more thing: observe a saying from Japanese “chuu-you de are,” “follow the middle of the road, i.e., all things in moderation.”