Xu, Hong (2002) Effects of Exercise and Traditional Chinese Medical Modalities on Bone Structure and Function. PhD thesis, Victoria University.

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.

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