Postmenopausal Osteoporosis and Aging Vs. Traditional Chinese Medicine

As previously stated, menopause is a turning point in a women’s life, a rite of passage that will commence the next step. Indeed, menopause itself has multiple symptoms that can be treated with herbs. Furthermore, using herbs from Traditional Chinese Medicine (TCM) is considered an alternative treatment for osteoporosis since most current treatments rely on hormone therapy, bisphosphonates, selective estrogen receptor modulators, etc. Nevertheless, these treatments can have secondary effects leading to increased risk of cardiovascular disease, breast, and endometrial cancer, gastrointestinal intolerances, to mention some. On the other hand, using herbs from TCM exerts therapeutic effects through a multi-component, multi-pathways, and multi-targeted way, according to postmenopausal osteoporosis physiopathology.

What is postmenopausal osteoporosis?

The etiology of postmenopausal osteoporosis is a systemic metabolic skeletal disease triggered by low estrogen concentration. Indeed, the rapid changes in hormonal levels in postmenopausal women increase the rate of bone remodeling.

 Furthermore, this condition characterizes by the high fragility of the bone tissue resulting in structural deterioration and increased risk of fracture, lower quality of life, increased morbidity and mortality rates. 

Osteoporosis affects 200 million postmenopausal women worldwide. As a chronic condition, postmenopausal osteoporosis needs long-term treatment with medication associated with adverse secondary effects. 

Therapeutic agents used for osteoporosis:

• Hormone replacement therapy has adverse long-term safety concerns. The long-term use of this therapy is associated with cardiovascular disease, endometrial and breast cancer, stroke, and venous thromboembolism.
• The use of bisphosphonates therapy links to gastrointestinal intolerance, jaw osteonecrosis, atrial fibrillation, and atypical femoral fractures.
• Salmon calcitonin associates with a higher risk of cancer.
• Parathyroid analogs are known to have secondary effects such as nausea, dizziness, and hypercalcemia.

Traditional Chinese Medicine and postmenopausal osteoporosis.

Herba Epimedium.

This herb has been used for centuries in TCM to treat a broad range of conditions like fatigue, sexual dysfunction, rheumatic diseases, and osteoporosis. Herba Epimedium, also known as YinYangHuo in Chinese, has around 260 bioactive compounds like icariin, icaritin, anhydroicaritin, and epimedin.

In vivo studies:

In vivo studies have shown that the Herba Epimedium extract prevented bone loss in ovariectomized (OVX) rats and improved biomechanical functions. Regarding turnover biomarkers, the group treated with Herba Epimedium showed lower urinary deoxypyridinoline levels, a marker of bone resorption.

Flavonoids derived from Herba Epimedium have a crucial role in modulating bone-formation pathways. Indeed, this same study showed an upregulation of procollagen type I N-terminal propeptide (PINP) and increased serum osteocalcin and type I collagen in OVX rats.

Icariin, a principal active constituent of Herba Epimedium, is associated with decreased tartrate-resistant acid phosphatase (TRAP) and bone alkaline phosphatase (BALP), as well as serum osteocalcin, C-terminal telopeptide of type I collagen (CTX) levels, and ALP activity. This coincides with reduced bone resorption. 

As far as genetic expression, the bioactive compounds found in Herba epimedium could be linked to better cognitive outcomes, resulting in reduced mobility loss. Components like icariin and TFE are linked to improved serum estrogen levels and an increase in estrogen receptor α (ERα) and ERβ mRNA expression of the hypothalamus and hippocampus. Consequently, this can reverse or slow the osteoporosis progression as well as improve neuroendocrine regulation.

In vitro results:

The findings associated with Herba Epimedium are outstanding, as its bioactive compounds can modulate cellular differentiation. Indeed, studies show that Herba Epimedium bioactive compounds can stimulate osteoblasts’ proliferation, differentiation, and mineralization. Furthermore, this mechanism also benefits the formation of osteoblasts instead of adipocytes, improving structural function and reducing fat mass. In addition, studies show that this herbal treatment inhibits the proliferation and differentiation of osteoclasts, promotes osteoclast apoptosis, therefore decreasing bone resorption.

Nowadays, we can look for a better way to treat this multi-pathway and multi-factorial condition with herbal components that promote better structure and modulate this condition from the root cause. The neverending list of adverse effects due to the excessive medication has left us no other option than to turn in another direction. Promoting the use of herbal therapy is a safer long-term alternative.- Ana Paola Rodríguez Arciniega, MS.

References:

Lin, Jing et al. “Chinese single herbs and active ingredients for postmenopausal osteoporosis: From preclinical evidence to action mechanism.” Bioscience trends vol. 11,5 (2017): 496-506. doi:10.5582/bst.2017.01216

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