Jade Acupuncture Clinic

Osteoporosis

The threat of bone loss is a common problem as people age. Osteoporosis causes the bones to become brittle, which raises the risk of bone fractures, especially in the hip, spine, and wrist. If not prevented or treated, osteoporosis can progress painlessly until a bone breaks. The fractures may require hospitalization and surgery. It can impair a person’s ability to walk, and may cause disability or even death.

Although osteoporosis runs in families, any woman with low estrogen levels, such as menopausal women, may begin to lose bone mass. Other factors contributing to osteoporosis are lack of calcium, stress, dieting, carbonated drinks, caffeine, smoking, eating disorders, lack of ovulation, heavy alcohol use, excessive sugar intake, and lack of exercise. Women who use or have used birth control pills have a 2.3 percent to 3.7 percent lower bone mineral density than those who never used the pill. Other medications, such as drugs used to treat hypothyroidism, can weaken bones as well
 

Both acupuncture and Chinese herbs can be helpful in treating osteoporosis.
 

Honora Wolfe notes that the single herbs Xu Duan and Du Zhong are commonly used to increase bone density in older patients. [1] 

According to John Chen, Lu Rong and Gui Ban are two herbs that are commonly used for bone-related disorders, and are both rich in calcium and magnesium, which are essential for bone health and for prevention of bone fractures. 

John Chen describes a clinical study in which Lu Rong and Gui Ban were given to 28 women to determine the effect of these herbs in the treatment of osteoporosis. The ages of the women ranged from 36 to 67, with an average age of 48.8 years. Osteoporosis was diagnosed and confirmed using bone mass density (BMD). The treatment protocol was to administer five grams of powdered extract of the herbal formula twice daily for one year. BMD was measured before and at the end of the trial. After one year of herbal therapy, there was an average increase of 3.4 percent BMD among the 28 women. The researchers concluded that the herbs are effective in the treatment of osteoporosis. [2] 

A study reported in the Townsend Letter for Doctors and Patients indicates that acupuncture can be effective in preventing osteoporosis in women after menopause. A clinical trial was conducted with 42 postmenopausal women ranging from 50 to 70 years old, who all had been diagnosed with osteoporosis using x-ray examination of the 2-4th lumbar vertebrae. The women in the treatment group received acupuncture using Bladder 23, Ren Mai 4, and Kidney 3. The treatment was given once every other day for three months, which was considered to be one course of treatment. After a 10 day rest, a second course of treatment was administered. Additionally, the women took one calcium and vitamin D supplement. The women in the comparison group were administered the calcium and vitamin D supplement, but did not receive acupuncture. After six months of treatment, all of the women were x-rayed again to measure their bone density. There was a significant increase of bone density from before and after treatment between the two groups, with the greatest benefit shown in the group receiving acupuncture. [3] 
 

The American Journal of Chinese Medicine details a study that also found that acupuncture may improve bone mass. In this study, rats had osteoporosis induced by ovariectomy. The acupuncture points used in this study were Spleen 6 and Pericardium 6, and treatment continued for 24 weeks. The results showed that acupuncture was helpful in improving bone mass. [4]

Diet
  
Diet is an important factor in bone health.
 
Tea drinking is associated with preservation of hip structure in elderly women, according to a cross-sectional and longitudinal study reported in the October issue of the American Journal of Clinical Nutrition. The analysis revealed that mean total hip bone mineral density was 2.8 percent greater in tea drinkers than in non-tea drinkers. [5] 

Foods with a high calcium content are recommended, due to calcium’s role in bone health. Not all women enjoy or can even tolerate dairy products, which are a good source of calcium, however there are other foods which can add calcium to the diet as well. Some examples of non-dairy foods with calcium content are ¼ pound of sardines with bones, which provides 200 mg. of calcium, 1 cup of cooked spinach, which provides 150 mg. of calcium, 4 ounces of tofu, which provides 145 mg. of calcium, 1 cup of cooked broccoli, which provides 130 mg. of calcium, and ¼ cup of almonds, which provides 80 mg. of calcium. 
 

Some additional foods that have a high calcium content are sea vegetables, such as wakame, (½ cup has 1,700 mg. of calcium), agar, (¼ cup contains 1,000 mg. of calcium), nori, (½  cup has 600 mg. of calcium), and kombu, (¼ cup contains 500 mg. of calcium.) One cup of tempeh contains 340 mg. of calcium, one cup of collard greens contains 355 mg. of calcium, one cup of milk contains 300 mg. of calcium, and one cup of enriched rice milk or soymilk has 300 mg. of calcium. Lentils are another source of calcium, with 50 mg. of calcium per cup. Yogurt contains 270 mg. of calcium per cup, black beans contain 60 mg. of calcium per cup, while sesame seeds contain 250 mg. of calcium per ½ cup.

Vitamin D is vital to the absorption of calcium. Some foods that are good sources of vitamin D are salmon, tuna, shrimp, egg yolks, fortified milk, and fortified cereals.  

“Prescription for Natural Cures” recommends that women eliminate sugar, refined grains, and soda pop from their diets. Reducing the intake of red meat is also suggested, since a high intake may contribute to bone loss in some individuals. A high salt intake is also linked to bone loss. Processed foods usually contain a high salt content, so they should be avoided as well. Caffeine and alcohol should be used in moderation, as both of these substances contribute to bone loss as well. [6] 

Exercise 
Weight-bearing exercise which stresses the bones stimulates them to lay down more bone tissue. It is recommended that women take part in some kind of aerobic, weight-bearing, and resistance exercise every week. However, the use of heavy weights or exercise that is too vigorous in women with osteoporosis might trigger a fracture, suggesting that gentler exercises might be more appropriate for those who already have osteoporosis
 

Several studies have shown that exercise is valuable for bone health.

When weight is put on bones during exercise, such as walking or strength-training, it stimulates the action of bone-building cells to help prevent too much bone from being broken down by the body, stabilizing bone mass. [7] 

German researchers reported that among early postmenopausal women with osteoporosis who were not being treated with medications, those who exercised four times a week had stable bone density;
those who did not exercise lost bone. [8] 

A study done at the University of Toronto showed that aerobic exercise, such as walking, jogging, or dance, improved the amount of calcium in the upper body and upper thighs, which are two areas at risk for fractures. [9] 

A randomized controlled study of 80 postmenopausal women with osteoporosis was conducted to investigate the effect of a home-based, simple, low-intensity exercise program. The participants in the study were instructed to lift their upper trunk from a prone position antigravity and maintain the neutral position. Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength, and decreasing the risk of vertebral fractures. [10] 

The Bone Estrogen Strength Training (BEST) study involved 320 sedentary but otherwise healthy post-menopausal women, aged 44 to 66, most of whom were osteopenic. The women were randomized to a regimen with strength training exercises or a non-exercise group. The workout involved three sessions a week of supervised, progressive weight-training with exercises to strengthen the small and large-muscle groups supporting the spine and hip, which are key areas associated with osteoporotic fractures. Scans were taken of the hip and spine before and after the one-year study period, and at follow up four years later
 After one year, there was an increase in bone density of around one percent at the hip and spine. After four years, those women who continued to exercise maintained the gains in bone density, while those who did not exercise lost bone. [11] 

It is recommended that women do weight-bearing aerobic exercise at least three times a week to maintain bone mass density, however any exercise, such as walking, is beneficial.
 
Calcium and Vitamin D   
Calcium is a major mineral in the body, with over 99 percent of the total body calcium located in the bones and teeth. Absorption of dietary calcium decreases with age, and may become critically impaired after the age of 70. Factors that increase calcium absorption include exercise, increase in vitamin D levels, intestinal acid, ingestion with a meal, acidic amino acids, and lactose. Factors that may decrease calcium absorption include aging, alcohol, alkaline medium in the intestine, fiber, vitamin D deficiency, emotional stress, excessive dietary phosphate, (the ideal calcium to phosphorus ratio is 2:1), medications such as glucocorticoids and anticonvulsants, high oxalates food sources such as spinach, sweet potatoes, rhubarb, beans, and nuts, and high phytate food sources such as unleavened bread and grains, raw beans, seeds, and soybeans. High protein, especially animal protein, can increase calcium excretion. High caffeine intake, carbonated soft drinks, and high sodium diets can also increase calcium excretion.
 

There are a number of forms of calcium. Calcium carbonate, such as coral calcium, dolomite, and oyster shell, contains the highest percentage of actual calcium. Calcium carbonate is best absorbed with meals and is poorly absorbed when acid secretion is minimal, such as at night or in a fasted state, and in individuals with hypochlorhydria or achlorhydria, which are common in elderly people. Common side effects of large doses of calcium carbonate include constipation and bloating. There have been reports of lead and aluminum being found in some forms of calcium carbonate, such as oyster shell, making the safety of this form of supplementation questionable
 

Calcium citrate and citrate malate are highly soluble, but have less actual calcium than calcium carbonate. These forms of calcium, however, are suitable for those with hypochlorhydria or achlorhydria, although a greater number of tablets need to be taken to obtain the required amount of calcium. Calcium lactate also has a high degree of solubility, and can be used as a supplemental form of calcium. Calcium citrate and citrate malate are best taken without food. There have been no reports of lead or aluminum being found in these products, making them a safer choice than oyster shell calcium.
 

The efficiency of calcium absorbed from supplements is greatest when calcium is taken in divided doses
 

According to the North American Menopause Society (NAMS), the recommended intake of calcium for peri- and post-menopausal women is 1,200 to 1,500 mg. per day. The tolerable upper limit for calcium is 2,500 mg. per day
 

Vitamin D is vital to calcium absorption. Without it, the small intestine cannot absorb calcium. A lack of vitamin D has been found in 30 percent of postmenopausal women with bone deterioration. Vitamin D and calcium taken together can inhibit hip fractures even after the age of 80, according to a research project done by a team of French scientists. In this 18 month study, half of the women were given daily supplements of 1.2 grams of calcium and 800 IU of vitamin D, and the other half of the women received a placebo. At the end of the study, the women receiving the supplements had a 40 percent lower rate of hip fractures and a 32 percent lower incidence of wrist, arm, and pelvic fractures. [12] 

A 2007 meta analysis found that 700 to 800 IU of vitamin D daily reduced hip fracture in elderly individuals by 25 percent. Studies selected for the meta analysis were randomized trials of oral vitamin D with or without calcium supplementation vs. placebo or no treatment in postmenopausal women and/or older men, aged 50 years or older. It was concluded that oral vitamin D appears to reduce the risk of hip fractures only when calcium supplementation is added. [13] 

Sunlight is a good source of vitamin D. Thirty minutes of direct sun exposure per day is necessary for the skin to convert cholesterol to vitamin D
 

The recommended dose for vitamin D is 400 IU for those over the age of 50, and 600 IU for those over the age of 70. Some experts recommend that all postmenopausal women take up to 800 IU of vitamin D.       
 

Copyright 2008 by Jeri Petz, MSOM, L.Ac., Dipl. Ac. (NCCAOM), Dipl. OM (NCCAOM)
Jade Acupuncture Clinic Ltd.    



[1] Wolfe, Honora Lee. Managing Menopause Naturally with Chinese Medicine. Boulder: Blue Poppy Press, 2005, p. 157. 
[2] Chen, John. “Estrogen and Chinese Herbs: Part Three in a Three Part Series: The Treatment of Osteoporosis:. California Journal of Oriental Medicine (CJOM): Winter 2001, Vol. 12, Issue 1: 14.
[3] Wolfe, Honora. “Acupuncture and Osteoporosis”, Townsend Letter for Doctors and Patients: April 2005.  
[4] Wenping, Zhang, Masayuki Kanehara, Yanjun Zhang, Xiaoming Wang, Torao Ishida. “Beta-Blocker and Other Analogous Treatments that Affect Bone Mass and Sympathetic Nerve Activity in Ovariectomized Rats”, American Journal of Chinese Medicine; Jan. 2007, Vol. 35 Issue 1:89-101. 
[5] Anon. American Journal of Clinical Nutrition. October 2007;86:1243-1247. (1 November 2007).
[6] Balch, James, Mark Stengler. Prescription for Natural Cures. Hoboken: John Wiley and Sons, 2004, p. 400. 
[7] Anon. “Best Bone Building Exercises”, Saturday Evening Post: Sept/Oct 2007, Vol. 279, Issue 5:80-81. 
[8] Ibid. 
[9] Flaws, Bob. Menopause and Chinese Medicine.  1st ed. Boulder: Blue Poppy Press, 2006, p. 199. 
[10] Hongo, M, E. Itoi, M. Sinaki, N. Miyakoshi, Y. Shimada, S. Maekawa, K. Okada, Y. Mizutani. “Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial”, Osteoporosis International: Oct 2007, Vol. 18, Issue 10:1389-1395. 
[11] Anon. “Best Bone Building Exercises”, Saturday Evening Post: Sept/Oct 2007, Vol. 279, Issue 5:80-81.
[12] Ojeda, Linda. Menopause Without Medicine. Alameda: Hunter House Inc., 2003, p. 147. 
[13] Boonen, S., P. Lips, R. Bouillon, H.A. Bischoff-Ferrari, D. Vanderschueren, P. Haentjens. “Need for Additional Calcium to Reduce the Risk of Hip Fracture with Vitamin D Supplementation”, J Clin Endocrinol Metab., April 2007;92(4) :1415-23.