Acupuncture alleviates osteoporosis related pain and improves bone mineral density. First Affiliated Hospital of Chengdu Medical College researchers conducted a controlled clinical trial. The team measured bone mineral density and serum osteocalcin before and after the study, along with visual analog scale (VAS) measurements of pain levels. Based on the scientific evidence, the researchers conclude that acupuncture reduces pain levels and promotes increased bone density in patients with osteoporosis. [1]
Prior to getting into the results, let’s go over the bone formation biomarker and bone density indicator used in the investigation. Bone mineral density was measured with dual-energy x-ray absorptiometry (DEXA) scans. The biomarker of bone formation was osteocalcin. Osteocalcin is a hormone present in bone. Cells that build bone (osteoblasts) secrete this protein and osteocalcin is a common marker of bone formation.
Osteocalcin is active in mineralization and has a natural diurnal pattern; osteocalcin levels naturally peak in the morning and are lowest in the afternoon. Glucocorticoid medications and alcohol reduce osteocalcin levels. Approximately 1–2% of bone protein is comprised of osteocalcin and it comprises approximately 15% of noncollagenous protein in bone. Circulating osteocalcin is cleared via the kidneys. As a result, osteocalcin levels may have limited accuracy as a biomarker for bone formation in patients with kidney disease. Other variations occur post-menopause (higher levels) and during pregnancy (lower levels).
Acupuncture was compared with calcium supplementation. Both approaches to patient care produced positive patient outcomes; however, acupuncture outperformed calcium supplementation. In the acupuncture group, there were 77 cases that had very effective results, 5 cases of effective treatment, and 9 cases of ineffective treatment. This produced a total effective rate of 90.10%. Mean bone mineral density increased from -2.50SD to 0.83SD, mean serum osteocalcin increased from 3.5mg/L to 6.2mg/L, and mean VAS scores dropped from 4.50 to 2.70 following treatment. The drop in VAS scores indicates reduced pain levels.
Calcium supplements produced beneficial results. In the calcium supplementation group, there were 57 cases that had very effective results, 16 cases of effective treatment, and 18 cases of ineffective treatment. This produced a total effective rate of 80.22%. Mean bone mineral density increased from -2.80SD to 0.63SD following treatment, mean serum osteocalcin increased from 4.0mg/L to 5.2mg/L and mean VAS scores dropped from 4.23 to 3.41 following treatment.
The data indicates that both treatment modalities produce clinical results. A follow-up investigation combining the therapies into an integrated protocol is appropriate given the positive patient outcome rates. It is possible that combining calcium supplementation with acupuncture may produce additive or synergistic effects.
Acupuncture and Moxibustion Osteoporosis has been recognised by Traditional Chinese Medicine (TCM) since its mention in texts as early as the Huang Di Nei Jing and Sun Simiao’s Qian Jin Yao Fang. In these texts, it is referred to as bone wilting or bone desiccation disease. Osteoporosis is primarily attributed to deficiency of the kidneys, since the kidneys are related to marrow production within the TCM system. This reflects the important relationship of the kidneys and bones.
Spleen and Stomach deficiency may also play a role in the pathology of this disease since they are responsible for ensuring a plentiful supply of qi and blood, which is necessary to nourish the bones. In the five element system, the relationship of the kidneys and spleen in this process is that spleen-earth regulates kidney-water. Another important relationship relative to osteoporosis treatment is that kidney-water is the mother of liver-wood.
Acupuncture treatment was administered according to the TCM principles of supplementing the liver and kidneys and strengthening the spleen. Points were selected on the foot Shaoyin, foot Taiyang, foot Taiyin, and foot Yangming channels. Points on the Governing Vessel and Back-Shu points were also used. The main points selected for the study were:
Baihui (GV20)
Dazhu (BL11)
Zusanli (ST 36)
Ganshu (BL18)
Shenshu (BL23)
Pishu (BL20)
Taixi (KD3)
Sanyinjiao (SP6)
Dazhui (GV14)
Mingmen (GV4)
Xuanzhong (GB39)
Huatuojiaji (MBW35)
Yaoyangguan (GV3)
Additional points used in the study included the following:
Yongquan (KD1)
Xuehai (SP10)
Taibai (SP3)
Weishu (BL21)
Weizhong (BL40)
Yanglingquan (GB34)
Sanjiaoshu (BL22)
Zhiyang (GV9)
First, a needle was inserted at Baihui, which was subsequently warmed with a moxa cigar for 15 minutes. Needles topped with a 1 cm piece of moxa were then inserted at Dazhu, Zusanli, Ganshu, Shenshu, and Pishu. The moxa was ignited after obtaining deqi using a lifting and thrusting reinforcing technique. All needles were retained for 30 minutes.
The remaining points were warmed for 30 minutes using only moxa. Treatment was administered once every two days, for a total of three consecutive months. Participants in the control group were prescribed calcium tablets (manufactured by Huishi Pharmaceuticals) to be taken orally, one tablet twice a day for a total of three consecutive months. Acupuncture group patients did not receive calcium supplementation.
Results and Discussion Results were obtained by measuring bone mineral density and serum osteocalcin before and after the study period. Bone pain scores were measured using a visual analog scale (VAS) from 0–10. A VAS score of 0 indicated no pain, a score of 1–3 indicated mild pain, a score of 4–6 indicated moderate pain interfering with sleep, and a score of 7–10 indicated severe pain.
Treatment was either rated as very effective (increased bone mineral density and resolution of clinical symptoms), effective (no further loss of bone mineral density and a reduction in clinical symptoms) or ineffective (bone mineral density and clinical symptoms unaffected or worse than pre-treatment levels). The total effective rate was calculated by adding together the number of participants with very effective and effective scores in each group.
Acupuncture produced a total effective rate of 90.10%. Mean bone mineral density and osteocalcin increases were greater in the acupuncture group than in the calcium supplementation group. VAS scores showed greater pain reduction in the acupuncture group than the calcium supplementation group.
Design A total of 182 participants were recruited for the study and were randomly assigned to receive warm needle acupuncture and moxibustion (n=91) or oral calcium supplementation (n=91). Outcome measures for the study included subjective bone pain (measured by the visual analog scale), serum osteocalcin, and bone mineral density. Bone mineral density was measured with dual-energy absorptiometry scans. The results of this scan were compared to the peak bone mineral density of a healthy young adult in order to determine a T score. T scores between +1 and -1 standard deviations (SD) indicate normal and healthy bone density. The participants recruited for this study had a bone mineral density T score lower than -2.0 SD or a 25% loss of bone mineral density, both of which are indicative of osteopenia or osteoporosis. All patients had exams confirming the presence of osteoporosis.
Summary The results indicate that acupuncture is just as effective in restoration of bone density in patients with osteoporosis as calcium supplimentation. While it also can decrease or stop pain, it can also build cartilage(as shown by other studies), improve walking and posture with regular treatment. Please call and check with your local acupuncturist for your treatment planning.
Reference: Wang Qiongfen, Jiang Yuan, Ai Haibo (2018) “Study on Prevention and Treatment of Primary Osteoporosis and Bone Loss by Supplementing Liver, Kidney, Spleen Warming Acupuncture and Moxibustion” Laboratory Medicine and Clinical Journal, 15 (14), pp.2046-2048.
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