The Effects of Acupuncture on Bone Mass Density and the

204 Pages·2014·0.76 MB·English

THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS

The Effects of Acupuncture on Bone Mass Density and the Biochemical Mechanisms Behind It:
A Research Synthesis

A Capstone Project
Submitted in Partial Fulfillment of the Requirements for the Degree
Doctor of Acupuncture and Oriental Medicine

By
Rochan Olson, M.A.T.C.M., L.Ac.

Capstone Advisor: Fritz Hudnut, D.A.O.M., L. Ac.

Yo San University
Los Angeles, California
March 2014

THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS 3

Abstract
Osteoporosis affects everyone. According to the World Health Organization (WHO,
2004), 55 % of the population over 50 has osteoporosis, and 80% of them are women. This
debilitating skeletal disorder accounts for most of the hip and vertebral fractures in post
menopausal women. Osteoporosis causes 1.5 million fractures per year and accounts for 17
billion dollars a year in medical costs (OLPC, 2009). Acupuncture may be an alternative and
complimentary treatment to western medicine. Acupuncture has a low incidence of side
effects and can have a systemic effect on the body by affecting not just the bones but the
whole body. This research synthesis will look at how acupuncture may help with this
debilitating disorder by examining the biochemical chain reactions that acupuncture influences,
and how those biochemical reactions effect bone mass density, bone health and bone
maintenance. This study will help both patient and doctors understand the science behind
acupuncture’s effect on the bones. This research study found that acupuncture had a positive
effect on osteoblasts, bone building cells biochemicals , as well as on estradiol and bone specific
alkaline phosphates. It was found that acupuncture helps down regulate osteoclast, bone
breakdown cells biochemicals; follicular stimulating hormone, TNF-α and osteocalin.
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS 4

Acknowledgements
I dedicate this paper to my grandmother Marie Hansen whose crumbling spine and severe pain
inspired me to do this project so that I could help my mom and others avoid osteoporosis. I
thank my family dearly, for without all their love and support I would not be where I am today.
You made it possible for me to complete my doctorate. Thanks for believing in me. I thank my
friends, Ellisa Benson, Maria Andino and Tracy Carter, for putting up with me through this
stressful process. To Chance, who knew when to stay and when to leave me alone, thanks for
helping me relax. To all my patients, I express thanks for your support and putting up with my
crazy schedule.
I would like to thank Yo San University for giving me the opportunity to take this journey in
researching this disease and growing into the doctor I wanted to be. I would like to thank my
advisor, Dr. Fritz Hudnut for his guidance and patient help. To Dr. Andrea Murchinson, thank
you for all your support and long hours. I thank Dr. Lau and Dr. Qian for forcing me out of my
comfort zone to be a better clinical doctor. To Dr. Ryan, for being an inspirational leader, caring
supportive soul and for making the DAOM program possible. And finally to my fellow
classmates, it wasn’t easy but by standing by each other we made it.
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS 5

Table of Contents
Chapter One: Introduction…………………………………………….…………………………………………….…………11
Osteoporosis Definition ……………………………………………………………………………….…….……….11
Research Question and Objective ………………………….………………………………………...…...……13
Definition of Terms and Abbreviations ….………………………………………………....….…….…...…16
Chapter Two: Literature Review……………………………………………………………………………….…21
A. Western Medicine Perspective on Osteoporosis ……………………………………………..……21
Osteoporosis Measurements……………………………………….……………………….………….21
Osteoporosis Causes……………………………………………………………………………..…….……19
Western Osteoporosis Treatments……………………………………………………….…....……25
Osteoporosis and Supplements…………………………………………………………………..……27
B. Traditional Chinese Medicine Perspective on Osteoporosis ……………………………..……..31
TCM Osteoporosis Definition…………………………………………………………………...……...31
TCM Herbal Treatments………………………………………………………………………….……….33
Electroacupuncture…………………………………………………………………………………...…….36
Chapter Three: Method…………….………………………………………………..……………..………………..….….40
Research Design…………………………………………………………………………………………………..………40
Sampling and Sampling Procedures…………………………………………………………………….……….41
Instrumentation and Data Collection Procedures………………………………………………………..42
Data Analysis……………………………………………………………………………………………………….………43
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS 6

Limitations……………………………………………………………………………………………………….….………46
Chapter 4: Results ………………………………………………………………………………………………….……………48
Biochemicals ……………………………………………………………………………………………………………….48
Estradiol ……………………………………………………………………………………….….……….……48
Estradiol Animal Studies………………………………………………………………………..………….49
Estradiol Human Studies…………………………………………………………………………….…..58
Points for Estradiol…………………………………………………………………………………….…….65
Follicular Stimulating Hormone ………………………………………………………….……….…..66
Follicular Stimulating Hormone Treatment Details ………………………………...……....70
Urinary Calcium ……………………………………………………………………………………………….70
Urinary Calcium Points……………………………………………………………………………………..72
Osteocalcin ………………………………………………………………………………………………………73
Osteocalcin Points………………………………………………………………………………………….…75
TNF-α ……………………………………………………………………………………………………………….76
TNF-α Points……………………………………………………………………………………………………..80
Deoxypridinoline ……………………………………………………………………………………………..80
Alkaline-phosphate ………………………………………………………………………………………….82
Alkaline-phosphate and Deoxypridinoline Points………………………………………………84
Biochemical Treatment Details ………………………………………………………………………..84
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
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A. Treatment
Frequency……………………………………………………………………………..84
B. Needle Retention Time and Study Length…………..………………….……………..85
C. Points…………………………………………………………………………………….……………….87
Bone Mass Density, Bone Formation, Strength ……………………………………………………………88
A. Bone Mass Density – Lumbar ……………………………………………………………………..88
B. Bone Mass Density – Tibia ………………………………………………………………………….91
C. Bone Mass Density – Femur ……………………………………………………………………….92
D. Bone Mass Density Points ………………………………………………………………………….94
Mineralization and Bone Formation rates ………………………………………………….…….95
A. Mineralization Apposition Rate ………………………………………………………95
B. Bone Formation Rate ……………………………………………………………………..95
C. Energy to Failure ……………………………………………………………………………98
Trabecular Separation, Number, Thickness ……………………………………………………………….101
A. Trabecular Separation ………………………………………………………………………………101
B. Trabecular Thickness and Number ……………………………………………………………103
C. Points for Trabecular Measurements………………………………………………………..105
D. Treatment Details for Bone Mass and Formation …………………………………….106
Treatment Details for All Studies ……………………………………………………………………………….108
A. Points………………………………………………………………………………………………………..108
B. Frequency…………………………………………………………………………………………………109
C. Type of Needles………………………………………………………………………………………..111
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
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Chapter 5: Discussion ……………………………………………………………………..…………………………………112
Summary of Findings …………………………………………………………………………………………………112
Implications of Theory ……………………………………………………………………………………………….112
Implications of Practice ……………………………………………………………………………………………..122
Limitations of Study …………………………………………………………………………………………………..127
Suggestions for Future Research ……………………………………………………………………………….128
Conclusion …………………………………………………………………………………………………………………129
Tables and Graphs
Table 1 – Estradiol Study Results Summary ………………………………………………….……………..49
Table 2 – Animal Studies Measurement Results on Estradiol ……………………………………….57
Table 3 – Human Studies Measurement Results on Estradiol ………………………………………64
Table 4 – FSH Study Results Summary ……………………………………….……….…………………….…66
Table 5 – Measurement Outcomes for FSH ………………………………………………………………….69
Table 6 – Measurement Outcomes for Urinary Calcium ………………………………………………72
Table 7 – Measurements Outcomes for Osteocalcin ……………………………………………………75
Table 8 – Measurement Outcomes for TNF-α ……………………………………………………………..82
Table 9 – Measurement Outcomes for Deoxyprodinoline (Dpd) ……………………….……..…82
Table 10 – Measurement Results for Alkaline-phosphate (ALP) ………………………………….83
Table 11 – Measurement Results for BMD – Lumbar ……………………………………………..…..90
Table 12 – Measurement Results for BMD – Tibia …………………………………………………….…92
Table 13 – Measurement Results for BMD – Femur ……………………………………………….……94
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS 9

Table 14 – Measurement Results for Mineral Apposition Rate (MAR) ……………….………..97
Table 15 – Measurement Results for Bone Formation Rate (BFR) ……………………………….98
Table 16 Measurement Results for Energy to Failure ……………………………………….……….101
Table 17 – Measurement Results for Trabecular sSparation (Tb.Sp.) …………………………103
Table 18 – Measurement Results for TrabecularThickness (Tb.Th.) …………………………...105
Table 19 – Measurement Results for Trabecular Number (Tb.N.) ………………………………105
Graphs
Graph 1 –Points for Estradiol ……………………………………………………………………………65
Graph 2 – Points Used for FSH …………………………………………………………………………70
Graph 3 – Points Used for Urinary Calcium ……………………………………………………..72
Graph 4 – Points Used for Osteocalin…………………………………………………………….…76
Graph 5 – Points Used for TNF-α …………………………………………………………………..…80
Graph 6 – Points Used for Deoxyprodinoline and Alkaline-phosphate ……………..84
Graph 7 – Treatment Frequency for Biochemicals ……………………………………………85
Graph 8 – Needle Retention Time for Biochemicals …………………………………………86
Graph 9 – Biochemical’s Needle Retention Time and Length of Treatment ………86
Graph 10 – Points Used for all Biochemical Studies ………………………………………….87
Graph 10.1 – Points Used for Bone Mass Density (BMD) Measurements …………95
Graph 11 – Points Used for Trabecular Studies ………………………………………………106
Graph 12 – Frequency of Treatments for Bone Formation and BDM Studies ….107
Graph 13 – Needle Retention and Treatment Length for Bone formation and
BMD Studies ……………………………………………………………………………107
THE EFFECTS OF ACUPUNCTURE ON BONE MASS DENSITY AND THE BIOCHEMICAL MECHANISMS
BEHIND IT: A RESEARCH SYNTHESIS 10

Graph 14 – Points Used for Bone Formation and BMD Studies ………………………108
Graph 15 – Points Used for All Studies ………………………………………………….……….109
Graph 16 – Needle Retention and Study Length for All Studies ………….………….110
Graph 17 - Treatment Frequency for All Studies …………………………………..……….111
Graph 18 – Amount of Hertz (Hz) used in EA Studies ……………………………..………112
Graph 19 – Type of Needling ………………………………………………………………………….112
References ……………………………………………………….……………………………………………..………………..131
Appendices
Appendix A: IRB Approval Letter....…………………………………………………………………………….141
Appendix B: Articles Used for Research Synthesis …………………………………………………..…143
Appendix C: Article Abstraction Form ………………………………………………………….…………….150
Appendix D: Table 1 Systems Studied…………………………………………………………….….….……152
Appendix E: Table 2 Type of Subjects Used ……………………………………………….……….…..…154
Appendix F: Table 3 Biochemical Markers Screened For……………………………..……..………157
Appendix G: Table 3.1 Biochemical Markers Screened for……………………………….…...……160
Appendix H: Table 4 Methods of Treatment………………….………………………………….….……166
Appendix I: Table 5 Treatment Details TCM…………………………………………………….…...……169
Appendix J: Table 6 Study Outcomes..……………………………………………………….……….………176