Acupuncture Continuing Education

Acupuncture Found Effective For Postmenopausal Osteoporosis

osteoclast osteoblast

Acupuncture outperforms calcium supplementation for the treatment of postmenopausal osteoporosis. Researchers from Huazhong University of Science and Technology (Wuhan, Hubei province) conclude that acupuncture is effective for the alleviation of pain and the regulation of osteoporosis-related cytokines in postmenopausal osteoporosis patients. The study was approved and funded by Hubei Provincial Natural Science Foundation. The results were published in Chinese Acupuncture and Moxibustion. [1] 

Three groups were compared. The calcium group received calcium carbonate tablets. The electroacupuncture group received acupuncture combined with electrical stimulation. The warm needling group received acupuncture and moxibustion.

Compared with the calcium and electroacupuncture groups, the warm needling group significantly reduced the visual analog scale (VAS) pain scores for postmenopausal osteoporosis patients. In addition, the research team measured biochemical responses to supplements and acupuncture, making important findings. The warm needling group significantly increased the serum insulin-like growth factor 1 (IGF-1) level and decreased serum interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) levels. The researchers conclude that warm needle acupuncture produces greater positive patient outcomes when compared with calcium supplementation and electroacupuncture.

 

Biomarkers and Mechanisms
Before getting into the results, let’s first take a look at the osteoporosis-related biomarkers and their clinical significance. The IGF-1 data demonstrates that acupuncture with moxibustion significantly increases IGF-1 and therefore contributes to improved skeletal health. Serum IGF-1 promotes the proliferation and accumulation of chondrocytes, synthesis of cartilage matrix, and activity of alkaline phosphatase from osteoblasts. These are important biomarkers in the maintenance of bone homeostasis, osteoblast differentiation, and cartilage formation. [2] In a previous study Xian et al. note, “Mice with osteoprogenitor cell knockout of the IGF-1 receptor had lower bone mass, a slower rate of dynamic bone formation and lower numbers of mature osteoblasts (but not osteoprogenitor cells) on bone surfaces than wild-type controls.” [3]

In many cases, IL-6 has the opposite function of IGF-1 and contributes to bone resorption. The study demonstrates that acupuncture downregulates IL-6 for patients with osteoporosis. IL-6 is a multifunctional cytokine formed by osteoblasts and monocytes. It contributes to bone resorption via stimulation of osteoclastogenesis. [4]

Acupuncture successfully downregulates TNF-α, which is a potent bone resorption inducer. It activates mature osteoclasts and inhibits their apoptosis by effecting osteoblasts. [5] In addition, TNF-α induces IL-6 release. [6] Overall, the biomarkers measured in the study indicate that acupuncture activates endogenous biochemical responses that counteract bone loss.

Osteoporosis is caused by an imbalance between osteoblast and osteoclast activity. In osteoporosis patients, the process of bone resorption induced by osteoclasts is faster than that of bone formation by osteoblasts, which results in bone loss. Osteoporosis is a common disease in postmenopausal women that seriously affects their quality of life. Research shows that there is a direct relationship between the lack of estrogen in postmenopausal women and the development of osteoporosis. In an independent study, Stuart et al conclude, “estrogens can modulate the production of cytokines, such as IL-1, TNF, and IL-6.” Their study finds that “estrogen inhibits the secretion of IL-1 and TNF-α.” [7]

 

Design
Researchers (Cai et al.) used the following study design. A total of 90 patients were treated and evaluated. All patients were diagnosed with postmenopausal osteoporosis. They were randomly divided into a calcium group, an electroacupuncture group, and a warm needling group, with 30 patients in each group. Inclusion criteria were as follows:

  • Ages 45–60 years
  • Course of disease range: 6 months–5 years
  • Bone density T value ≤ -2.5, measured by dual-energy X-ray absorptiometry (DEXA)

Patients with the following conditions were excluded from the clinical trial:

  • Endocrine and metabolic diseases (e.g., hyperparathyroidism, Cushing's syndrome, hyperthyroidism, hyperthyroidism, diabetes)
  • Blood diseases (e.g., myeloma, leukemia)
  • Severe gastrointestinal diseases
  • Mental and nervous system disorders

The statistical breakdown for the randomized groups were as follows. The average age in the calcium group was 51 (±6) years. The average course of disease in the calcium group was 3.4 (±1.6) years. The average age in the electroacupuncture group was 50 (±6) years. The average course of disease in the electroacupuncture group was 3.5 (±1.7) years. The average age in the warm needling group was 51 (±6) years. The average course of disease in the warm needling group was 3.3 (±1.6) years. No significant statistical differences in age and course of disease relevant to patient outcome measures existed for patients entering the study.

 

Treatment Procedure
In the calcium group, 600mg of calcium carbonate tablets were prescribed, to be ingested once a day for a total of 30 days. The electroacupuncture and warm needling groups received acupuncture treatments at the following acupoints bilaterally:

  • Dazhu (BL11)
  • Shenshu (BL23)
  • Xuanzhong (GB39)

Upon disinfection, acupuncture needles were perpendicularly inserted into the acupoints, up to a 15–20 mm depth. The electroacupuncture group received 10 Hz of electric stimulation on the acupoints, while the warm needling group received moxibustion by attaching a 2 cm moxa cutting to each needle handle. The total needle retention time per treatment was 30 minutes. Acupuncture was administered once per day, for a total of 30 days.

 

Evaluations and Results
The changes in the visual analogue scale (VAS), serum insulin-like growth factor1 (IGF-1), interleukin6 (IL-6), and tumor necrosis factor (TNF-α) were observed before and after treatments in the three groups. VAS scores were all reduced after treatment. The decrease in the warm needle acupuncture group was the most obvious (6.73 ± 0.24 before treatment vs. 4.43 ± 0.26 after treatment). Values after warm needle acupuncture treatment varied compared with patients in the electroacupuncture (5.13 ±0.31) and calcium groups (5.17 ±0.33). Serum IGF-1 levels improved after treatment in the warm needling acupuncture group (119.5 ng/mL before treatment vs. 156.5 ng/mL after treatment), which was more significant compared with the electroacupuncture (136.3 ng/mL) and calcium (127.7 ng/mL) groups’ post-treatment values.

 

Summary
Clinical and laboratory results indicate that acupuncture is effective for the treatment of osteoporosis patients. Application of acupoints Dazhu (BL11), Shenshu (BL23), and Xuanzhong (GB39) are the acupoints used in investigation and are proven to produce subjective and objective results. Patients interested in learning more are recommended to contact a local licensed acupuncturist.

 

References:
[1] Cai GW, Li J, Xu XJ, et al. Clinical Research on Warm Acupuncture Therapy for Pain in Postmenopausal Osteoporosis [J]. Chinese Acupuncture and Moxibustion, 2014, 34(1):25-27.
[2] Carney EF. Bone: modulation of IGF-1 might prevent Osteoporosis [J]. Nat Rev Rheumatol, 2012, 8 (8): 440.
[3] Xian, L. et al. Matrix IGF-1 maintains bone mass by activation of mTOR in mesenchymal stem cells. Nat. Med. 2012 Jul;18(7):1095-101.
[4] Ara T, Declerck Y A. Interleukin-6 in Bone Metastasis and Cancer Progression[J]. Eur J Cancer, 2010, 46(7): 1223-1231.
[5] Yang N, Wang G, Hu C, et al. Tumor Necrosis Factors Suppresses the Mesenchymal Stem Cell Osteogenesis Promoter Mir-21 in Estrogen Deficiency-induced Osteoporosis [J]. J Bone Miner Res, 2013, 28(3): 559-573.
[6] Tanabe, K., Matsushima-Nishiwaki, R., Yamaguchi, S., Iida, H., Dohi, S., & Kozawa, O. (2010). Mechanisms of Tumor Necrosis Factor-Α-Induced Interleukin-6 Synthesis in Glioma Cells. Journal of Neuroinflammation, 7(1), 16.
[7] Ralston S H. Analysis of gene expression in human bone biopsies by polymerase chain reaction: evidence for enhanced cytokine expression in postmenopausal Osteoporosis [J]. J Bone Miner Res, 1994, 9(6): 883-890.

 

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