 Abstract | Bone loss often leads to osteoporosis. This is a disease characterised by low bone mass
and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility
and a consequent increase in fracture risk. Osteoporosis is a complicated syndrome
whose treatment and prevention crosses many disciplinary boundaries: therefore it is
multidisciplinary. The best form of treatment is prevention. Osteoporosis can be
limited through the maximization and maintenance of bone strength and minimization
of trauma.
The purpose of this study was to consider the effects of: physical activity in the form of
Tai Ji (Tai Chi), acupuncture and Chinese herbal medicine on bone loss by evaluating
bone structure and function in menopausal women. The effects of these modalities
were objectively examined through changes in bone material properties and the
biomarkers of bone metabolism. Broadband ultrasound attenuation (BUA), a measure
of bone structure and density, velocity of sound (VOS), an indicater of the elastic
modulus and the breaking forces of bone as provided by ultrasound parameters, were
evaluated. The levels of osteocalcin (OSTN) in serum, a biomarker of bone formation
and the levels of pyridinoline (PYR) and doxypyridinoline (D-PYR) in urine, which are
bone resorption markers were evaluated as parameters of bone metabolism. Traditional
Chinese Medicine diagnosis was also used to measure changes in participants’
symptoms resulting from Tai Ji exercise, acupuncture and herbal treatment.
During an eight month paired cross-over study the effects of three traditional Chinese
therapeutic strategies (as described above) on bone structure and function to prevent
bone loss were evaluated. Menopausal women are considered one of the most at risk
groups for bone loss. Forty menopausal women who completed treatment and testing
were divided into three sub groups; 12 into the Tai Ji exercise group, 14 into the
acupuncture treatment group and 14 into the herbal treatment group. The groups were
then further divided into treatment and control groups. The sub-group for each
treatment underwent a four month regime while the control group maintained a normal
lifestyle. At the end of the fourth month the groups changed roles with the control
group undergoing treatment while the former treatment group reverted to a normal
lifestyle. Relevant tests were carried out at the beginning of the study, at the end of the
4th month and at the end of the study (at the end of the 8th month).
Subjects in the Tai Ji group completed thirty-two one hour sessions of Beijing 24-
movements Tai Ji over sixteen weeks. These movements are designed to gather qi,
focus the mind, relax the body, move qi and blood, exercise the muscles, joints and
lumbar region. The set of movements improve the balance function of the body and
strengthen the muscles and sinews.
The results of this study indicated that Tai Ji improved bone structure and increased
bone density in menopausal women. There was a 7.3% increase in BUA (p=0.001)
when comparing the test results of Groups A+B pre and post Tai Ji exercise. The
increased BUA appears to be associated with 39.0% increased bone formation
(p=0.001) rather than decreased bone resorption (p > 0.05). Tai Ji exercises also relieved
symptoms related to bone loss. It appears that Tai Ji exercise may not only improve
balance and confidence in the elderly but also could contribute to improved bone
function and structure.
The subjects who received acupuncture therapy were assessed according to the
principles of traditional Chinese Medicine. Three main acupuncture points in the lower
legs, KID 3, SP 6 and ST 36 were used in accordance with the common pattern of
disharmony for each of the fourteen participants. Each of the subjects was treated 32
times by the researcher, twice a week for 16 weeks, the duration of each treatment was
30 minutes. The treatment involved the use of points on meridians that tonify and
nourish the body. The use of specific acupuncture points on the kidney, stomach and
spleen meridians meant that their related organs were tonified, nourished and regulated.
Acupuncture of points KID 3, SP 6 and ST 36 tended to increase BUA 8.8% (p=0.005)
when comparing the test results of Groups A+B pre and post treatment. The balance
between bone formation and resorption improved, OSTN increased 30.9% (p=0.006)
which indicates an improvement in bone formation, D-PYR was reduced by 18.5%
(p=0.002) indicating a decrease in bone absorption, when comparing the test results of
Groups A+B pre and post acupuncture treatment. Acupuncture can also strengthen
kidney as evidenced by the relief of symptoms reported in this study.
The participants who received traditional Chinese herbal therapy were assessed
according to the principle of Traditional Chinese Medicine. “Shu Di Shan Zha
formula” was selected for the treatment group in accordance with the common pattern
of disharmony. The decoction (granules mixed with water) was taken twice per day
over a period of four months to strengthen the kidney and nourish yin.
Chinese medical herbal therapy – Shu Di Shan Zha formula was able to affect the level
of BUA (6.9% increase for Groups A+B pre and post treatment, p=0.03) and a
reduction in the level of D-PYR (16.5% decrease for Groups A+B pre and post
treatment, p=0.011) in menopausal women as well as ameliorating menopausal
symptoms in most of the subjects. However the mechanism of herbal therapy on bone
turn-over warrants further study.
Broadband ultrasound attenuation (BUA) was higher after the treatment with these three
different strategies. Increased levels of osteocalcin (OSTN) in serum and the decreased
levels of pyridinoline (PYR) and doxypyridinoline (D-PYR) in the urine were all noted
after the treatments and might explain the increased BUA. Results of dual energy X-ray
absorbtiometry (DEXA) in the same subjects had a moderate correlation with the BUA
readings (r=0.50). BUA is considered a valuable measure of bone structure and density.
The study suggests that the three modalities relieve menopausal and bone loss related
symptoms. The results imply that the three traditional Chinese therapeutic strategies
might delay the occurrence of bone loss by improving the balance of bone turn over and
general health in menopausal women. |
