Thursday, 10 December 2015

Most Common Diseases of elder: The Clinical Trials and Studies of Musculo-Skeletal disorders: Osteoporosis - The Natural Plantbased Phytochemicals

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia


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

                               The Prevention and Management 
The prevention and management of osteoporosis are always important due to the prevalent of the diseases in  in all populations and all ages(221), especially to elder, causing a significant physical, psychosocial, and financial consequences(220).

The  Phytochemicals
Phytochemicals found in plants, especially on their skins, play an important and biological role in human health protection and against many forms of diseases(333). According to the animal and cellular studies by Royal Botanic Gardens, phytochemicals found in dried plum and citrus and berry fruits and dietary phytochemicals exhibited a positive association of reduced risk of osteoporosis(334) through improved BMD, microarchitecture integrity, and bone strength(334).
1. Flavonoid
 Flavonoid, a group of phytochemicals, including catechin, and the main ingredient of green tea, have found to process certtain anti diseases and health protective effects, including cardiovascular disease (CVD), cancer and diabetes, epidemiologically(335). (-)-Epigallocatechin, epigallocatechin found in Drynariae rhizoma improved bone metabolism, anti-osteoporiotic activities(336) and resorptive action in bone cells(337).through extraction efficacy of polyphenolic compounds in antioxidant activity(336), the Health Care Products Research Laboratories and Dongguk University College of Oriental Medicine(337) suggested.
In deed, the reduction of oxidative stress or chronic low-grade inflammation by phytochemicals such as flavonoids is associated positively between total dietary intake and bone mineral density(338).

2. Phenolics
Phenolics found abundantly in fruits, especially in the skin, including anthocyanins and stilbenoids,.. may be a potential phytochemicals in decreased the imbalance of bone turn over on bone metabolism induced risk of osteoporosis(339). According to the Guangdong Medical College study, phenolics isolated from the 70% ethanol extract of the roots of Livistona chinensis, exhibited anti-osteoporosis effects through reduction of oxidative stress involved bone formation by osteoblastic cells(340) in rat.
In comparison between pre- and postmenopausal women for effectiveness of phenolics from an oleuropein-rich olive (Olea europaea) leaf extract the Safety and Bioactivity of Plant Foods suggested that intake of olive phenolics mayprevent age-related and oxidative stress-related osteoporosis(341),

4. Curcumin
Curcumin a diarylheptanoid of turmeric, is a member of the ginger family (Zingiberaceae) and best known for its antioxidant effects in enhancing the immune system for fighting of the forming of free radicals and foreign invasion of that induced acute and chronic diseases(342). Some researcher has suggested to use curcumin for treatment of various musculoskeletal disorders, such as osteoarthritis, osteoporosis, musculocartilaginous disorders,... due to its efficacy as antioxidant with a significant medicinal properties, such as anti-inflammatory and anti-neoplastic activities(344).
In glucocorticoid-induced osteoporosis, administration of curcumin in dose dependent-manner promote over all bone health by increased BMD and bone-alkaline phosphatase, decreased carboxy-terminal collagen cross links, enhanced bone mechanical strength, and improved trabecular microstructure, according to Shengjing Hospital of China Medical University in rat study(343).
The analytic study of the combination of conjugated GNPs (CGNPs), which can form inclusion complexes with curcumin (CUR-CGNPs) has also found to process a significantly improved bone density and prevented bone loss activities through inhibiting osteoclast (OC) formation and osteoclastogenesis in bone marrow-derived macrophages(345).
5. Phloridzin
Phloridzin, another antioxidant found mainly in apple has found to process anti high blood glucose levels and improve lipids metabolism in animal model(346). According to the Unité des Maladies Métaboliques et Micronutriments, in aging induced change of sex hormones related of that lead to inflammatory and oxidant condition, phloridzin prevented imflammatory condition in ovariectomy-induced bone loss, and improved bone resorption(347).

6. Pectin
Pectin, is a structural heteropolysaccharide found mainly in the in the primary cell walls of  terrestrial plants. Pectin Rhamnogalacturonan-Is (RG-Is) isolated from potato and apple may be an important phytochemical in increased osteoprotective effects mediated via antioxidant or anti-inflammatory pathways and their downstream signaling mechanisms(349), such as in increased mineralized matrix formation of osteoblastic cells through production of high amount of galactan in vitro, according to joint study lead by Copenhagen University Hospital Glostrup(348).

Due to proven effects of phytochemicals  in bone health, there is a suggestion in determination of scientist to provide the effective doses of phytochemicals and their metabolites in improving bone mass, microarchitecture integrity, and bone strength of that may reduce the occurrence of osteoporosis(349).

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(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) Osteoporosis(Life extension)
(5) Growth hormone and bone by Ohlsson C1, Bengtsson BA, Isaksson OG, Andreassen TT, Slootweg MC.(PubMed)
(6) GH and bone--experimental and clinical studies by Isaksson OG1, Ohlsson C, Bengtsson BA, Johannsson G.(PubMed)
(205) New advances in imaging osteoporosis and its complications by Griffith JF1, Genant HK.(PubMed)
(207) Severe osteoporosis: diagnosis of non-hip non-vertebral (NHNV) fractures by Giovanni D’Elia,1 Giuliana Roselli,1 Loredana Cavalli,2 Paolo Innocenti,1 and Maria Luisa Brandi2(PubMed)
(208) Whole bone geometry and bone quality in distal forearm fracture by Parkinson IH1, Fazzalari NL.(PubMed)
(209) Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density inosteoporosis by Shiraki M1, Shiraki Y, Aoki C, Miura M.(PubMed)
(210) Short-term menatetrenone therapy increases gamma-carboxylation of osteocalcin with a moderate increase ofbone turnover in postmenopausal osteoporosis: a randomized prospective study by Shiraki M1, Itabashi A.(PubMed)
(211) Association of Body Weight and Body Mass Index with Bone Mineral Density in Women and Men from Kosovo by Rexhepi S1, Bahtiri E2, Rexhepi M1, Sahatciu-Meka V3, Rexhepi B1.(PubMed)
(212) Should we prescribe calcium or vitamin D supplements to treat or prevent osteoporosis? by Bolland MJ1, Grey A1, Reid IR1.(PubMed)
(333) The role of phytochemicals as micronutrients in health and disease by Howes MJ1, Simmonds MS.(PubMed)
(334) Fruits and dietary phytochemicals in bone protection by Shen CL1, von Bergen V, Chyu MC, Jenkins MR, Mo H, Chen CH, Kwun IS.(PubMed)
(335) The role of phytochemicals as micronutrients in health and disease by Howes MJ1, Simmonds MS.(PubMed)
(336) In vitro anti-osteoporosis properties of diverse Korean Drynariae rhizoma phenolic extracts. by Kang SN1, Lee JS2, Park JH3, Cho JH4, Park JH5, Cho KK6, Lee OH7, Kim IS8.(PubMed)
(337) Inhibitory activity of Drynariae rhizoma extracts on cathepsin having bone resorption Jeong JC1, Yoon CH, Jeong CW, Lee YC, Chang YC, Kim CH.(PubMed)
(338) The effects of flavonoids on bone by Welch AA1, Hardcastle AC.(PubMed)
(339) In vitro anti-osteoporosis properties of diverse Korean Drynariae rhizoma phenolic extracts by Kang SN1, Lee JS2, Park JH3, Cho JH4, Park JH5, Cho KK6, Lee OH7, Kim IS8.(PubMed)
(340) The phenolics from the roots of Livistona chinensis show antioxidative and obsteoblast differentiation promoting activity by Zeng X1, Tian J2, Cui L3, Wang Y4, Su Y5, Zhou X6, He X7.(PubMed)
(341) Bioavailability of phenolics from an oleuropein-rich olive (Olea europaea) leaf extract and its acute effect on plasma antioxidant status: comparison between pre- and postmenopausal women by García-Villalba R1, Larrosa M, Possemiers S, Tomás-Barberán FA, Espín JC.(PubMed)
(342) Curcumin, an atoxic antioxidant and natural NFkappaB, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: a shield against acute and chronic diseases by Bengmark S1.(PubMed)
(343) Curcumin alleviates glucocorticoid-induced osteoporosis by protecting osteoblasts from apoptosis in vivo and in vitro by Chen Z1, Xue J2, Shen T1, Ba G1, Yu D1, Fu Q1.(PubMed)
(344) Role of Curcumin in Common Musculoskeletal Disorders: a Review of Current Laboratory, Translational, and Clinical Data by Peddada KV1, Peddada KV2, Shukla SK3, Mishra A3, Verma V4.(PubMed)
(345)Inhibition of osteoclast differentiation by gold nanoparticles functionalized with cyclodextrin curcumincomplexes by Heo DN1, Ko WK, Moon HJ, Kim HJ, Lee SJ, Lee JB, Bae MS, Yi JK, Hwang YS, Bang JB, Kim EC, Do SH, Kwon IK.(PubMed)
(346) Phloridzin reduces blood glucose levels and improves lipids metabolism in streptozotocin-induced diabetic rats by Najafian M1, Jahromi MZ, Nowroznejhad MJ, Khajeaian P, Kargar MM, Sadeghi M, Arasteh A.(PubMed)
(347) Prevention of bone loss by phloridzin, an apple polyphenol, in ovariectomized rats under inflammation conditions by Puel C1, Quintin A, Mathey J, Obled C, Davicco MJ, Lebecque P, Kati-Coulibaly S, Horcajada MN, Coxam V.(PubMed)
(348) Osteoblastic response to pectin nanocoating on titanium surfaces by Gurzawska K1, Svava R2, Yihua Y3, Haugshøj KB3, Dirscherl K4, Levery SB5, Byg I6, Damager I7, Nielsen MW8, Jørgensen B6, Jørgensen NR9, Gotfredsen K10.(PubMed)
(349) Fruits and dietary phytochemicals in bone protection by Shen CL1, von Bergen V, Chyu MC, Jenkins MR, Mo H, Chen CH, Kwun IS.(PubMed)

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