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Wednesday, 28 January 2015

(Preview) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Osteoarthritis

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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Osteoarthritis

Osteoporosis is condition of thinning of bone and bone tissues as a result of  the loss of bone density over a long period of time. 

I. Symptoms
1. Lower back pain, as a result of fractured or collapsed vertebra

People with Osteoporosis are susceptible to lower back pain than those without osteoporosis, according to a cross-sectional study, conducted from October 2002 to March 2003 to gather data from 24,435 adults aged 20 years and older selected randomly from Taiwan’s general population. The Osteoporosis rate of frequent low back pain in association with osteoporosis in men and women were 5.77 and 3.49 respectively(1).

2. Loss of height over time

Vertebral fracture cause of spinal core damage is associated to significant height loss in patients with osteoporosis, according to a study of 231 men and women over the age of 65 underwent DXA scan of their spine and hip (2).
  Osteoporosis patients with chronic obstructive pulmonary disease (COPD) are found to associate to excessive height loss(3).


3. A stooped posture
Postural deformity of patients with osteoporosis is associated to contributed risk factor for postural instability and falls.  Spinal curvature on postural instability in patients with osteoporosis may
influence lumbar kyphosis(lower back curvature)  in spinal inclination(4).

4. Easy bone fracture 

Easy bone fracture  may be results of a gradual loss of bone density.
 Intravenous infusion of zoledronic acid (5 mg) at 12 months, found that Zoledronic acid treatment was associated with a significantly reduced risk of vertebral fracture(
fractures in the spine, hip and wrist), among men with osteoporosis, according to a multicenter, double-blind, placebo-controlled trial of randomly assigned 1199 men with primary or hypogonadism-associated osteoporosis who were 50 to 85 years of age(5).

5. Neck and low back pain
  Neck and low back pain,
frequent in female are prevalent and highly associated in patients with headache and osteoporosis, according to 1-year prevalence of neck pain and low back pain in the Spanish population(6).

6.  Depression

Spine BMD was negative correlations between anxiety, stress, but depression was found to have a unique significant contribution to the explained variance in right and left hip BMD(7).

7. Other symptoms
Women with osteoporosis  re more likely to experience certain
psychosomatic, gastrointestinal and swelling and vasomotor symptoms, especially depressive symptom if compared to women in generally good health(8).
8. Etc.

II. Causes and Risk Factors
A. Causes
1. Process of wear and repair

Osteoarthritis (OA) is a widespread degenerative disease of skeletal joints and often associated with senescence in vertebrates due to excessive or abnormal mechanical loading of weight-bearing joints,  arising from heavy long-term use or specific injuries(6).
Improper repair process of injure of joints can also result of symptoms of Osteoarthritis (OA) in old age, according to TCM. 


2. Nutrient deficiency
Poor nutritional conditions in early life are linked to greater prevalence of OA due
the gradual deterioration of function(9).

3. Cartilage
Cartilage is a flexible connective tissue which cushions the ends of bones in your joints to allow the joints to move smoothly. If the cartilage becomes rough  or wears down due to aging or damage, it can cause pain as a result of  bone in the joint rubbing against another bone.


4. Etc.

B. Risk factors
1. Young Age at Diagnosis, Male Sex, and Decreased Lean Mass

According to Korea Cancer Center Hospital, Seoul,
a. Diagnosed before attainment of puberty, were showed to have a higher prevalence of osteoporosis
b.  If you are males, you are at increased risk of osteopenia or osteoporosis than females
c.  Regional lean mass was significantly associated to the reduce risk of affecting the limbs
(12).

2. Adult growth hormone replacement

Adult growth hormone replacement, were identified to associated to increased risk of osteoporosis and osteopenia, according to the study by Seoul National University College of Medicine(13).

3. Aging

Risk of  osteoporosis increases with age.
Bone loss occurs during the normal aging process. In women, natural menopause also effect the additional bone losses,  according to the study by Department of Medicine, College of Physicians and Surgeons, Columbia University(14).


4. Chlamydia pneumoniae
  Individual presented of Chlamydia pneumoniae DNA  are alsp associated to both in osteoporotic bone tissue(15).


5. Race
Lactose maldigestion showed a greater affect on low bone density. Extensive lactose maldigestion among Hispanic-American and Asian-American populations may elevate the risk for osteoporosis(16).


6. Family history
According to the reported physician-diagnosed osteoporosis and family history in a representative sample of U.S., family history is associated to a significant, independent risk factor for osteoporosis in U.S. women aged>or=35 years(17).


7. Body size
  Large body size is associated to the risk of the development of osteoporosis and a salutary effect on BMD in both blacks and whites, in a study of
three groups of postmenopausal women: 104 healthy black women, 45 healthy white women, and 52 osteoporotic white (18).
 
8.  Diet and lifestyle

BMD was higher in habits of alcohol drinking, green tea drinking, and physical activity and lower in those with the habits of smoking and cheese consumption, in a study of total of 632 women age > or =60 years(19).

9. Heavy alcohol intake or alcoholism
Heavy alcohol intake or alcoholism, however, frequently disrupts calcium and bone homeostasis, leading to reduce bone mineral density and increase the incidence of fragility fracture, according to the study by Department of Endocrinology and Metabolism, Saitama Medical School(20).


10. Smoking and lower serum IGF-I levels
  A lower BMI is found in patient who are current smoking history and lower serum IGF-I levels in middle-aged Korean men(21).


11. Other risk factors
The frequency of decreased bone mineral density, low vitamin and calcium diet content and insufficiency with vitamins are found among patients suffering from chronic diseases (of cardiovascular system, gastrointestinal tract, osteopenia and osteoporosis)(22).

III. Diagnosis According to the Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada, Screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations.

If you are experience certain symptom of osteoporosis, the tests which your doctor order include
1. Blood and urinary tests
The aim of the tests is to check for the bone metabolism and the progression of bone (loss) diseases.

2. Dual energy X-ray absorptiometry (DXA)
Dual energy X-ray absorptiometry (DXA) is one most common test to measure the total bone density of including spine, hip, wrist etc. with accurate result. 


3. Quantitative Ultrasound and computed tomography (QCT)
 Quantitative ultrasound (QUS) is a
portable and accurate technology used to  evaluate bone density at the lumbar spine and hip without the use of ionizing radiation.
Computed Tomography (CT) scanner.a technology for measuring properties of bone at peripheral skeletal sites(23).
Dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT), which are now the standard methods for assessing osteoporosis severity and treatment efficacy(24), but in cross-sectional study of males with glucocorticoid-induced osteoporosis (GIO, quantitative computed tomography (QCT), High-resolution quantitative computed tomography (HRQCT)-based  were more superior to DXA in discriminating between patients of differing prevalent vertebral fracture status(25).


4. Etc.

IV. Complication associated with Osteoporosis 
Pain, Fractures, Vertebral, Wrist, Rib fractures are associated with Osteoporosis, according to the study of New advances in imaging osteoporosis and its complications(26)

V. The Diet
1. Green tea
Black tea polyphenol, theaflavin-3,3′-digallate (TFDG) and green tea, epigallocatechin-3-gallate (EGCG)  are found to be a lead compounds for the treatment of bone resorption diseases, through
inhibition of the formation and differentiation of osteoclasts, according to study.

2. Organic soy
  Ingestion soy isoflavone extracts (not soy protein or foods containing isoflavones)
supplements increased lumbar spine BMD in menopausal women, but not femoral neck, hip total, and trochanter BMD, according to study.

3. Milk thistle seeds

Silibin found abundantly in Milk thistle seeds has shown to  promote bone-forming osteoblastogenesis and encumber osteoclastic bone resorption in vitro cell systems of murine osteoblastic MC3T3-E1 cells and RAW 264.7 murine macrophages.

4. Skin and seed of grape
Resveratrol, a phytohemical of
skin and seed of grape promoted spontaneous osteogenesis(bone formation) but prevented adipogenesis(adipocytes in storage of fat) in human embryonic stem cell-derived mesenchymal progenitors, according to study. 

VI. Antioxidants and Osteoporosis

Dietary and endogenous antioxidants were consistently lower in patients with osteoporosis, according to University of Perugia, leading to decrease antioxidant defenses and promoting pathogenesis of osteoporosis(32).

2. Selenium plus vitamins E and C

In rabbits study, combination of vitamins E and C given partially prevented this bone tissue destruction on the progress of osteoporosis. When combine with sodium selenite given together with vitamins E and C to the osteoporosis model rabbits, the long bone tissue of osteoporosis rabbits had almost the same structure as in normal rabbits(33).

3. Vitamin C
According to the study epidemiologic studies, correlate low vitamin C intake and
genetic deletion of enzymes involved in de novo vitamin C synthesis are associated to bone loss and severe osteoporosis, respectively(34).

4. Calcium and vitamin D 
Calcium supplements showed to reduce the rate of bone loss in osteoporotic patients. According to 
SENECA study, calcium treatment not only on bone mass but also on fracture incidence and vitamin D insufficiency is frequent in elderly populations in Europe. Supplementations with daily doses of 400-800 IU of vitamin D, given alone or in combination with calcium, are able to reverse vitamin D insufficiency, to prevent bone loss and to improve bone density in the elderly, according to  University of Siena(35)
5. Etc.

VII. Treatments
A. In conventional medicine perspective

A.1. Bisphosphonates
1. Including Alendronate (Fosamax), Risedronate (Actonel, Atelvia), Ibandronate (Boniva), Zoledronic acid (Reclast, Zometa), etc.. Bisphosphonates are antiresorptive medications widely prescribed for treatment of osteoporosis. The drugs have shown to significantly reduce the risk of osteoporotic fractures(36). Higher risk patients should be treated by
nonbisphosphonatefor 10 yr,  have a holiday of no more than a year or two(37).

2. Side effects
a. Nausea
b. Abdominal pain
c. Difficulty swallowing
d. Rrisk of an inflamed esophagus or esophageal ulcers(38)
e. Risk of scleritis and a variety of ocular side effects(39)
f. Etc.


2. Hormone-related therapy 

Hormone replacement therapy can help to maintain bone density for menopause women, but it increases
a, The risk of breast cancer and heart disease(40)
b. The risk for venous thromboembolism(41)
c. The risk of (Nonmelanoma Skin Cancers) NMSC.(42)
d. The risk of stroke(43)
e. etc.

B. In herbal medicine perspective
1. Red clover
 

 Red clover extract (RCE) standardized to contain 40% isoflavones by weight (genistein, daidzein, biochanin A, and formononetin present as hydrolyzed aglycones) together with a modified alkaline supplementation have shown to improve OVX-induced osteoporosis while a mild metabolic alkalosis might further synergize some therapeutic aspects(44).

2.  Organic soy
Soybean protein showed to promote higher rate of bone turnover in fed animals, together with enhancement of ertebral and femoral bone densities, according to
nonbisphosphonate(45).

3. Soybeans, clover and alfalfa sprouts, and oilseeds (such as flaxseed)
In humans, animals, dietary phytoestrogens found in soybeans, clover and alfalfa sprouts, and oilseeds (such as flaxseed) play an important role in prevention of menopausal symptoms, osteoporosis, cancer, and heart disease(46).
4. Etc.

C. In traditional Chinese medicine perspective

 Osteoporosis in elder is a condition of the drop of Kidney Jing. As we age, our kidney doesn’t have the energy to nourish the bones. The weak and brittle bone can, lead to the symptoms of earaches, ringing in the ears, hearing loss, hair loss, teeth problems, knee pain and lower back pain, loss of sex drive, including osteoporosis.

1. Du-Huo-Ji-Sheng-Tang and Du Zhong (Cortex Eucommiae) 
Du-Huo-Ji-Sheng-Tang and Du Zhong (Cortex Eucommiae) was the most frequently prescribed herbal formula and single herb, respectively, for the treatment of osteoporosis, according to the study by the
Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital(47).


2.  Zuogui Pill
  Zuogui Pill showed effectively in preventions and treatments of glucocorticoid-induced osteoporosis in rats by up-regulating the expression of the key signal molecules inWnt signal transduction pathway(
pass signals from outside of a cell through cell surface receptors to the inside of the cell)(48).

3. Embedding thread at Shenshu (BL 23)
  Embedding thread at Shenshu (BL 23) was found to increase BMDs of hip and lumbar vertebrae in patinets with osteoporosis. The rate of bone fracture during 5 years after treatment was 2.1%  significantly lower than 18.2% in the medication group(49).


4. Shaoyang Meridians 
 Foot-Shaoyang Meradians can modulate bony strength under physiological and pathological conditions, and treat osteoporosis which mainly manifests as ostealgia and easy fracture, according to
Huangdi’s Internal Classic(50).

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Reprinted from Norton Journal, Volume I, Most Common Diseases of Ages of 50 Plus - Chapter of Musculoskeletal disorders (MSDs) - Osteoarthritis by Kyle J. Norton


References
(a) http://www.ncbi.nlm.nih.gov/pubmed/7864688 
(1) http://www.ncbi.nlm.nih.gov/pubmed/23052969 
(2) http://www.ncbi.nlm.nih.gov/pubmed/20870048
(3) http://www.ncbi.nlm.nih.gov/pubmed/22896775
(4) http://www.ncbi.nlm.nih.gov/pubmed/19343468
(5) http://www.ncbi.nlm.nih.gov/pubmed/23113482 
(6) http://www.ncbi.nlm.nih.gov/pubmed/21079541
(7) http://www.ncbi.nlm.nih.gov/pubmed/23095987
(8) http://www.ncbi.nlm.nih.gov/pubmed/23149863 
(7) http://www.ncbi.nlm.nih.gov/pubmed/20618843
 (12) http://www.ncbi.nlm.nih.gov/pubmed/23128330
(13) http://www.ncbi.nlm.nih.gov/pubmed/22057549 
(14) http://www.ncbi.nlm.nih.gov/pubmed/12699295 
(15) http://www.ncbi.nlm.nih.gov/pubmed/23160916 
(16) http://www.ncbi.nlm.nih.gov/pubmed/11349943
(17) http://www.ncbi.nlm.nih.gov/pubmed/18541176
(18) http://www.ncbi.nlm.nih.gov/pubmed/8422511 
(19) http://www.ncbi.nlm.nih.gov/pubmed/17657549 
(20) http://www.ncbi.nlm.nih.gov/pubmed/15632479
(21) http://www.ncbi.nlm.nih.gov/pubmed/15221500
(22) http://www.ncbi.nlm.nih.gov/pubmed/19348280
(23) http://www.iscd.org/visitors/pdfs/10-QuantitativeUltrasoundintheMgmtofOsteo.pdf
(24) http://www.ncbi.nlm.nih.gov/pubmed/23154276 
(25) http://www.ncbi.nlm.nih.gov/pubmed/23149277
(26) http://www.ncbi.nlm.nih.gov/pubmed/22618377 
(32) http://www.ncbi.nlm.nih.gov/pubmed/12679433
(33) http://www.ncbi.nlm.nih.gov/pubmed/14677021 
(34) http://www.ncbi.nlm.nih.gov/pubmed/23056580
(35) http://www.ncbi.nlm.nih.gov/pubmed/11683549 
(37) http://www.ncbi.nlm.nih.gov/pubmed/20173017
(38) http://www.ncbi.nlm.nih.gov/pubmed/23137577
(39) http://www.ncbi.nlm.nih.gov/pubmed/14702129
(40) http://www.ncbi.nlm.nih.gov/pubmed/20424287
(41) http://www.ncbi.nlm.nih.gov/pubmed/19811247
(42) http://www.ncbi.nlm.nih.gov/pubmed/22215431
(43) http://www.ncbi.nlm.nih.gov/pubmed/21612355 
(44) http://www.ncbi.nlm.nih.gov/pubmed/19503771
(45) http://www.ncbi.nlm.nih.gov/pubmed/8558297 
(46) http://www.ncbi.nlm.nih.gov/pubmed/9240932
(47) http://www.ncbi.nlm.nih.gov/pubmed/23093986
(48) http://www.ncbi.nlm.nih.gov/pubmed/21977807 
(49) http://www.ncbi.nlm.nih.gov/pubmed/20568431
(50) http://www.ncbi.nlm.nih.gov/pubmed/18630551