A Conjoint Approach For The Management Of Osteoporosis

Author

Khan Usmanghani, Faculty of Eastern Medicine, Hamdard University, Karachi-7460, Pakistan.

Proceeding

1st International Conference & Exhibition on Women's Health & Asian Traditional (WHAT) Medicine

Date

23/8/2005

Keyword

Osteoporosis, traditional medicine, ipriflavone, Boerhaavia repens L., flavonoid glycosides

Abstract

Osteoporosis, state of low bone mass is one of the major problems in our aging society. Osteoporosis results in bone fracture in older members of the population, especially in post- menopausal women. It is well known that parathyroid hormone (PTH) plays an important role in the regulation of the calcium metabolism of bone and is widely used as a bone resorption stimulator in bone-tissue-culture systems designed to evaluate the direct effects of compounds under test. In traditional medicine, there are many natural crude drugs that have the potential for use to treat bone diseases; however, not much laboratory work has been reported evaluating this possible use. One example, however, is ipriflavone, a natural product derivative, has been shown to have an inhibitory effect on osteoclasts while stimulating osteoblasts. Several studies on postmenopausal women have shown that ipriflavone does have a protective effect against bone loss. In a search for natural crude drugs having inhibitory activity on bone resorption, we have screened a number of plants widely used in traditional medicine for their inhibitory activity on bone resorption induced by PTH in organ culture. Among these crude drugs, a methanolic extract of Boerhaavia repens L. (Nyctaginaceae) was found to be active and has been targeted for the present study. A methanolic extract from the whole plant of Boerhaavia repens was found to inhibit bone resorption induced by parathyroid hormone (PTH) in tissue culture. Systematic separation of the methanolic extract afforded one new and two known flavonoid glycosides, namely, eupalitin 3-O-b-D- galactopyranosyl-(1→2)- b-D-glucopyranoside (1), eupalitin 3-O-b-D-galactopyranoside (2), and 6-methoxykaempferol 3-O-b-D-(1→6)-robinoside (3). The structure of the new compound 1was determined using spectroscopic techniques. The inhibitory activity of these substances toward bone resorption induced by PTH was evaluated, and compounds 1 and 2 were found to exhibit significant activity. A comparative study of Boerhaavia repens with raloxifene was conducted in different hospitals. This study enlisted 86 patients at random, out of 48 were diagnosed as osteoporotic from different age group. The associated diseases data on hypertensive, diabetes, arthritis and thyrotoxcicoses of these osteoporotic patients were recorded. The clinical study on raloxifene were conducted for a period of three years in which the number of responding patients continued with the therapy the tally remained at14. Similarly in others designed group which were treated with Boerhaavia repens 18 patients registered but after a period of three years only 8 patient continued with the treatment. Both types of the clinical evaluation were conducted for bone mineral density, bone alkaline phosphatase and serum calcium level. The exclusion criteria observed for the osteoporotic patients include the fracture of the long and hipbone. The range of alkaline phosphatase in post menopausal women without any pathology should be 22-30mg/dl. But in case of osteoporosis this range exceeded up to 80-100mg/dl. After treatment of the selected group of post menopausal osteoporotic women by reloxifene the alkaline phosphatase found to be in the normal limits up to 35mg/dl. When the other group of post menopausal women treated by Boerhaavia repens the level decreased to the range of 32mg/dl. In case of serum calcium, the calcium level decreases up to 6-8mg/dl from the normal range of 8-10mg/dl. With reloxifene, the additional supplements of calcium were administered at the recommended dose of 800-1000mg/day. The T – score indicated how many Standard Deviation (SD) a patients BMD is from the young adult BMD i.e. T – score expresses the percentage (%)Young Adult (YA) value in a different way. Patients with T – score above –1 considered as normal with the BMD up to 1.42 - 1.54 g/cm2, while incase of osteoporosis the value of T – score suggestive of osteoporosis up to –2.5 to –5 with decreased value of BMD i.e. 0.82 – 0.58g/cm2 with increased risk of fracture. The group of patients treated with reloxifene showed the improvement in T – Score up to –2 to –1.5 with BMD up to 1.1g/cm2. The other group of patients treated with Boerhaavia repens showed significant improvement in the T – Score up to the range of –1.5 to –1 with BMD level 1.18 g/cm2. The Boerhaavia repens showed marked improvement in the level of bone alkaline phosphatase and bone mineral density whereas, calcium level was found static. Further statistical studies are in progress.