“A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF CONSTITUTIONAL MEDICINES VERSUS PICRICUM ACIDUM IN THE MANAGEMENT OF CERVICAL SPONDYLOSIS”

 ABSTRACT

Cervical spondylosis (CS) is also called as cervical osteoarthritis, it is a degenerative disease of cervical intervertibral disc and their associated intervertebral joints. The term covers the pathology in the spine and the neurological syndrome associated with it “SPONDYLO” is a Greek word meaning vertebra and spondylosis generally mean changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.

This comparative study is an attempt to assess the Effectiveness of Constitutional Homoeopathic Remedies versus Picricum Acidum in the management of Cervical Spondylosis.

METHODS:

A total number of 30 cases meeting the inclusion and exclusion criteria, comparing both sexes between 30-60 years, diagnosed with cervical spondylosis based on NDI scoring up to 30, and presenting common symptoms, were induced. Group 1 patients received constitutional remedies and group 2 patients received Picricum Acidum.

RESULT AND DISCUSSION:

Out of 30 subject, 8 subjects recovered (26.6%), 13 subjects improved (43.3%) and 9 subjects (30.1%) did not improve. Notably , most patients experienced marked symptomatic relief.

  CONCLUSION:

This case record analysis suggests a potential beneficial effect of Picricum Acidum 30 C  potency in managing cervical spondylosis. Most patients experienced symptomatic relief, although caution is warranted due to study limitations. Future research, including well-designed randomized controlled trials with larger sample size, is needed to establish the efficacy and safety of Picricum Acidum 30 C  potency in cervical spondylosis patients.

KEY WORDS:

Homoeopathy , Cervical Spondylosis, Constitutional medicine, Picricum Acidum, Cervical spine.

INTRODUCTION

Cervical spondylosis (CS) is also called as cervical osteoarthritis, it is a degenerative disease of cervical intervertibral disc and their associated intervertebral joints. The term covers the pathology in the spine and the neurological syndrome associated with it “SPONDYLO” is a Greek word meaning vertebra and spondylosis generally mean changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.

Cervical spondylosis is characterized by pain in the neck with or without radiation, tingling, numbness and paraesthesia and in later stages there is spondylotic myelopathy of the upper extremity. Radiologically, reduction in the intervertebral disc space and formation of marginal osteophyte is observed.

PREVALANCE

The lifetime incidence of neck-related pain in the population has been reported to be as high as 67%. Point prevalence has been placed at 3.5/1000,while the annual incidence has been reported at 83/100,000 population. 

International incidence of cervical spondylosis is 2.5 cases per 1000 population and door to door study conducted in India shows an incidence of 3.5 cases per 1000 population.

Nearly 50% of people over the age of 50 and 75% of those over age of 65 have typical radiographic changes of cervical spondylosis. Symptoms of cervical spondylosis may appear in those as young as 30 years and are most commonly in those aged 40-60 years.

Indian population reported that 78% of radiological changes of cervical spondylosis, is seen at C5-C6 & C6-C7 levels in asymptomatic individuals. 

ETIOLOGY

1. Wear and tear on joints that accompanies aging(osteoarthritis)

2. Arthritis (inflammation of joint)

3. Trauma such as automobile accidents with whiplash injury, athletic injuries, sudden jerks on arms and falls.

Whiplash injury is due to trauma (usually automobile accidents) causing cervical Musculo ligamental sprain or strain due to hyperflexion or hyperextension.

 

There are several predisposing factors, which may cause acceleration of these changes.

1. There may be a hereditary predisposition to intervertebral disc disease.

2. Previous injury with fracture or disc prolapses

3. Occupations requiring repetitive motion of the cervical spine.

4. Segmentation defects like hemivertebra or fused vertebrae.

5. Fluorosis may play an important part in the development of ossified posterior longitudinal ligament in India.

PATHOLOGY

Degenerative changes begin with intervertebral disc desiccation, which is associated with increase in the ratio of keratin sulfate to chondroitin sulfate. Along with desiccation, the nucleus pulposus shrinks, loses elasticity, and becomes more fibrous due the loss of water, protein and mucopolysaccharides during the aging process. Disc height is initially lost in the ventral portion of the disc, which results in a decrease in cervical lordosis. Unfortunately, this process results in positive feedback cycle due to the increase in forces applied ventrally and eventually may lead to kyphotic deformity. These early changes ultimately lead to the main pathophysiological process of cervical spondylosis, a reduction in sagittal spinal canal diameter. Additionally, these changes cause a transfer of axial load onto the facet joints, resulting in hypertrophy of joints that further decreases the spinal canal’s diameter.

DIAGRAM: 1 PATHOPHYSIOLOGY

 

 

CLINICAL MANIFESTATIONS :

1. Axial neck pain

2. Cervical radiculopathy

a. Sensory change, such as tingling, known as Paraesthesia

b. Sensory loss to the skin in the dermatome (the area of skin innervated by the nerve)

c. Weakness in the myotome (the muscles innervated by the spinal nerve)

d. Diminished, or absent, reflex in the muscles controlled by the spinal nerve

e. Pain felt along the path of the spinal nerve (radicular pain). 

3. Cervical myelopathy

DIAGNOSTIC CRITERIA:

NDI -SCORING: Up to 30

DIAGNOSIS:

X-rays, computed tomography (CT), and magnetic resonance imaging (MRI), Doppler ultrasound and electrodiagnosis (electrodiagnosis and nerve conduction studies and somato sensory evoked potential).

TREATMENT:

HOMOEOPATHIC VIEW OF CERVICAL SPONDYLOSIS :

 

MIASMATIC UNDERSTANDING OF PRIMARY OSTEOARTHRITIS:

 

Hahnemann tells in chronic diseases that the swellings of the bones and the curvature of the spine, and many other softening and deformities of the bones, both at an early and at a more advanced age, are caused by the psora. Under symptoms of latent Psora- “disposition to crack, strain or wrench one joint or another. Cracking of one or more joints on moving”

Hahnemann also mentions, when the outbreak of the internal Psora occurs- “thickening of joints; they remain hard swollen, and there is pain on bending them. The joints, as it were, stiff, with painful, difficult motion, the ligament seems too short. Joints painful on motion. Joints crack on moving, or they make a snapping noise.

RUBRICS FOR CERVICAL SPONDYLITIS:

1. MURPHY – Diseases

Spondylitis, neck

Murphy - Diseases

Torticollis, spondylitis suboccipital is, from

2. S.R. PHATHAK

Neck, spondylitis 

spondylitis, cervical 

3. WILLIOM.O. BOERICKE

Nape, of neck, pains, in general

Nape, of neck, pains, rheumatic

Neck, cracking of cervical vertebrae, on motion

4. COMPLET REPERTORY

Back -Spondylitis cervical

5. KENT REPERTORY

Back - cracking - Cervical region

Back - pain - Cervical region

Back - stiffness - Cervical region

Extremities - pain - Upper limbs – neuralgic

PICRICUM ACIDUM INDICATION:

Neurasthenia. Occipital pain; worse, slightest mental exertion.

Vertigo and noises in ear. Burning along spine.

Worse ; least exertion, after sleep, wet weather; patient is worse then.

Better, from cold air, cold water, tight pressure.

PREVENTION OF CERVICAL SPONDYLOSIS 

Since cervical spondylosis is part of the normal aging process, not much can be done to  prevent it. By engaging in regular physical exercise and limiting occupational or recreational activities that place pressure on the head, neck and shoulders may help to avoid some or all symptoms of cervical spondylosis. The best exercises for the health of the cervical spine are noncontact activities, such as swimming, walking, or yoga. Once symptoms have already developed, the emphasis is on symptom management rather than prevention.

OBJECTIVES:

To study the clinical course of cervical spondylosis from the age group of 30-60 years.

 To assess the efficacy of homoeopathic constitutional medicine and Picricum Acidum in the treatment of cervical spondylosis.

MATERIALS AND METHODS:

SOURCE OF DATA:

The subjects for the study were selected from OPD, IPD, Peripheral centers, rural health camps and medical camps conducted by SIVARAJ Homoeopathic Medical College and Research institute, Salem. 30 subjects were selected based on inclusion criteria and exclusion criteria.

INCLUSION CRITERIA:

1. Subjects of all genders.

2. Subjects of age group between 30-60years.

3. Subjects are selected based on clinical history, clinical examination, clinical features of cervical spondylosis & with investigations.

4. Diagnosed cases of cervical spondylosis.

5. Subjects who give written consent.

EXCLUSION CRITERIA:

1. Subjects below 30 & above 60 years.

2. Subjects with traumatic injury of cervical spine.

3. Adhesive Capsulitis

4. Cervical Myofascial Pain.

5. Whiplash injury.

6. Spinal cord injury

7. Prolapsed intervertebral disc

8. Pregnant & lactating women.

9. Patient suffering from any systemic disease.

        METHODOLOGY:

Subjects were selected based on inclusion and exclusion criteria, history, clinical findings. The data were represented in the standardized case proforma prepared for the topic. There were two groups wherein Group 1 was treated with constitutional medicines & group 2 was treated with Picricum Acidum.  

Table No 1: Results of Z test

Outcome Measures	Group 1 p1	Group 2 P2	Z value (computed)	P value
Recovered	0.1	0.33	2.28	±1.96
Improved	0.33	0.53	6.6	±1.96
Not improved	0.13	0.46	1.3	±1.96

 

        SUMMARY AND CONCLUSION:

Samples of 15 subjects – 15 subjects in each group were studied and totality of symptoms. Was gathered in Group 1, each case Totality was further Analysed, Repertorized and referred in Materia Medica to arrive at the most appropriate remedy that would benefit the case under consideration. In Group 2, Picricum Acidum was prescribed, based on totality.

According to statistical analysis using Z test, it may be concluded that Constitutional homoeopathic medicine is more effective than Picricum Acidum from in the management of cervical spondylosis.

ü In Group 1, the most common constitutional remedy prescribed was Rhus Tox for 4 subjects (26.6%), out of which 2 subjects got recovered, 1 subject improved and 1 subject not improved.

ü As in this study Rhus Tox was indicated in 4 subjects followed by Lycopodium in 3 subjects, Nux Vomica, Sulphur & Pulsatilla in 2 cases with marked improvement, one can think of, Ignatia and Cal. Carb as primary remedies in the management of cervical spondylosis.

ü Out of 30 subjects, 8 subjects recovered (26.6%), 13 subjects improved (86.6%) and 9 subjects (30%) did not improve.

ü The most common age group affected was seen from 30-35 years (36.6%) followed by 36 - 40 years of age group (26.6%), followed by 46-50 years of age group (16.6%), followed by 41-45 & 51-55 years of age group (10.1%).

ü In this study, male patients were more than females. 21 subjects (70%) were males, and 9 subjects (30%) were females.

ü According to the occupation, Car driver, bus drivers, tailor and painter 3 subjects each (40.1%), followed by mechanics, housewife, Teacher, Labor, 4 subjects each (53.3%), and IT worker 2 subjects each (6.6%).

Table :2 Distribution of subjects as per remedies

REMEDY	NO OF SUBJECTS	PERCENTAGE   (%)
CALCAREA CARBONICA	1	6.6
NUX VOMICA	2	13.4
PULSATILLA	2	13.4
LYCOPODIUM	3	20
RHUS TOX	4	26.6
SULPHUR	2	13.4
IGNATIA	1	6.6
TOTAL	15	100

 

Out of 15 subjects, in 4 subjects (26.6%) Rhus Tox was prescribed, 3 subjects (20%) lycopodium was prescribed in 2 subjects (13.4%) Nux Vomica, Sulphur and Pulsatilla was prescribed Calcarea Carbonicum, Ignatia was prescribed 1 subject (6.6%).

 

 

 

 

 

 

 

 

 

 

Table 3: Distribution of subjects as per the results in Group 1 and Group 2.

 

RESULTS	NO. OF SUBJECTS		PERCENTAGE (%)		TOTAL
	GROUP 1	GROUP 2	GROUP 1	GROUP 2	NO	%
Recovered	5	3	33.3	20	8	26.6
improved	8	5	53.3	33.4	13	43.3
Not Improved	2	7	13.4	46.6	9	30.1
Total	15	15	100	100	30	100

 

Statistical study was done to show the results. Out of 15 subjects in Group1, 5 subjects (33.3%) recovered, and 8 subjects (53.3%) improved, and 2 subjects (13.3%) did not show any improvement and out of 15 subjects in Group2, 3 subjects (20%) recovered ,5subjects (33.4%) improved and 7 subjects (46.6%) did not showed any improvement.

GRAPH NO 1: COLUMN GRAPH SHOWING DISTRIBUTION OF SUBJECTS ACCORDING TO CONSTITUTIONAL HOMOEOPATHIC REMEDIES PRESCRIBED.

                                  

GRAPH NO 2: BAR GRAPH SHOWING DISTRIBUTION OF SUBJECTS

 

  Summary and conclusion

All the 30 subjects were studied in detail and assessed by using the following parameter- Neck disability index score. Neck disability index score was measured before and after treatment. The statistical analysis made in this study was based on the data from Neck Disability index score.

Patient will be selected based on inclusion and exclusion criteria. Patients will be categorized in to two groups, Group-I will be receiving only constitutional treatment, Group-II will be receiving only Picricum Acidum.

· In this study, male patients were more than females. 21subjects (70%) were males, and 9 subjects (30%) were females.

· Hindus were more affected by cervical spondylosis 27 subjects (90%), 3 subjects in Christian (10%).

· In this study, out of 15 subjects in Group1, 6 subjects were from age group 30-35(40%), 4 subjects from age group 36-40(33.3%), 1 subject from age group 41-45(6.8%),2subjects from age group 46-50(13.3%) and 2subjects from age group 51-55(13.3%).

· And out of 15 subjects in Group2, 4 subjects were from age group 30-35(26.6%), 5 subjects from age group 36-40(33.3%), 2 subject from age group 41-45(13.3%),3subjects from age group 46-50(20%) and 1subjects from age group 51-55(6.8%).

· Out of the 15 subjects in Group 1, 11 were male and 4 were female and out of 15 subjects in Group 2, 10 were male and 5 were female.

· In this study in Group -I (Constitutional treatment) Male patients are 11(73%) and Female patients are 4(27%), Group-II (Picricum Acidum) male patients are 10(66.6%) and Female patients are 05(33.4%), in this total study 30% (09 patients) were female 70% (21 patients) were male.

· Out of 15 subjects , in 3 subjects (20%) lycopodium was prescribed and in 4 subjects (26.6%) Rhus Tox was prescribed, in 2 subjects (13.4%) Nux Vomica, Sulphur and Pulsatilla was prescribed Calcarea Carbonicum, Ignatia  was prescribed 1 subject (6.6%).

· Statistical study was done to show the results. Out of 15 subjects in Group1, 5 subjects (33.3%) recovered, and 8 subjects (53.3%) improved, and 2 subjects (13.3%) did not show any improvement and out of 15 subjects in Group2, 3 subjects (20%) recovered, 5subjects (33.4%) improved and 7 subjects (46.6%) did not show any improvement.

 

REFERANCE

1. Naaz Ayesha,  Ri zwan Farha. Historical overview of cervical spondylosis. IJRSRNov2015;Vol 6(11):7155-7157. ( cited on 11/2/19)

2. Sadler T W. Langman’s medical embryology, 10^th edition . Witless klumer health pvt ltd, New delhi,125, 140 – 141.

3. Datta A K. Essentials of human embryology ,Skeletal system & development of teeth, 5^th edition. Current books international publications, Kolkata2007; 291-292 .

4. Romanes GJ . Cunningham’s manual of practical anatomy, The head & neck, 1

5. 5^th edition. vol 13. oxford medical publications , New York 2007;1

6. Chaurasia BD . Human anatomy head & neck brain, 6^th edition. vol 3, CBS publishers & distributors pvt ltd 2013; pg 50-54.

7. Worth R David. Movements of cervical spine, Aust. J. Physiotherapy, 2june 1970; vol 14(2): 84-85 ( cited on 19/1/19)

8. Joshi Jayanth & Kotwal Prakash . Essentials of Orthopaedics and Applied Physiotherapy, B.I. Churchill Livingston pvt ltd, New Delhi; 386-392

 

9. Mullin Jeffrey, shedid Daniel, benzer Edward.Overview of cervical spondylosis pathophysiology & biochemics. WSCJ sep 2011, vol 2(3); 89-97 (cited on 1/1/19)

10. kogta Ajay, Sarode Rajendra . Prevalence of cervical & spondylosis & outcomes;A hospital-based study. international journal of recent trends in science & technology;september2015:16(2);307-308.¹⁷ :(cited on 18/02/17)

11. Ware Adinath Rajashri,Pawar Ankush vinay. An Ayurvedic view of cervical spondylosis and its management with mocharasa-siddha taila nasya. IJAAR 6mar-apr2016:2(6):806-812. (cited on 18/11/2017)

12. okada E matsumato, M Ichihara D et.al; Aging of cervical spine in healthy volunteers, 1 april 2009; 34(7). Pg no 706-712

13. Walter R Frontera, walter P Frontera, Julie K Sivar. Frontera essentials of physical medicine & Rehabilitation, 1edition. Lippincott Williams wilkines publishers ; 12-15

14. Christopher.G.Goetz, Eric.J.Pappert, Textbook of clinical neurosurgery, W.B.Saunders Company, 544 – 546.

15. Davidson’s Principles and Practice of Medicine, 19th edition, Churchil Livingston, Harcourt Brace and company Ltd. 1189 – 1191.

16. Sankaran Rajan. Homoeopathy The Science of Healing. World Homoeopathic Links, New Delhi. 1984: 23-28.

17. Hahnemann Samuel, Organon Of Medicine,6ed.New Delhi:B Jain Publishers;2008:94

18. Rottler Gaby.Dr. GHG Jahr’s view on constitutional symptoms, explained in a historical context. Hpathy Ezine;2013(4) Hpathy.com/homoeopathy-papers/constitution-and-chronic- diseases-the-value-of-constitutional-symptoms-as-seen-by-g-h-g-jahr.

19. Dhawle M. L, Concept of Disease in Homoeopathy .Environmental & Constitutional Factors. Principles & Practice Of Homoeopathy Part I.3^rded.Published by Institute Of Clinical Research ;2000:38

20. Schepper De Luc .Constitution, Timeline & Temperament, Hahnemannian Textbook Of Classical Homoeopathy For The Professional.NewDelhi.Jain publishers:142-143.

21. Samuel Hahnemann , the chronic diseases their peculiar nature and their homoeopathic cure, B. Jain publisher pvt.ltd, New Delhi,2009;95, 103, 129-130

22. Biman Mandal, miasmatic diagnosis in homoeopathy, new central book agency pvt. Ltd, Kolkata-india, first published-2003, page no- 41, 51, 80,Speight Phyllis, A comparison of the chronic miasms, psora, pseudo-psora, syphilis, sycosis, reprinted in india by arrangement with C.W Co, Ltd. England-948 by B Jain publishers, New Delhi; 75.

23. Ortega Sanchez Proceso, notes on the miasms or Hahnemann’s chronic diseases, published by national homoepopathic pharmacy, new delhi, English translated by Dr. Harris coulter,first English edition-1980,72, 93.

24. Banerjea Kumar Subrata, miasmatic diagnosis practical tips with clinical comparisons, B.Jain publishers pvt.ltd, New Delhi; revised edition-2003; 90, 91, 92, 93, 94.

25. Murphy Robin. Homoeopathic Medical Repertory,2^nd edition.(reprint edition) B.jain publishers(p) ltd. New Delhi; 2008: 1466-1469.

26. Phatak S R, A Concise repertory of homoeopathic medicines, 2^nd edition.neck – spondylitis, the homoeopathic medical publishers, Bombay;248-249.

27.  Boericke William, new manual of homoeopathic material medica and repertory, 14^th edition.B.jain publishers.pvt.ltd, New Delhi;879.

28. Complete Repertory, Roger von Zandvoort, B.jain publishers.pvt.ltd, New Delhi.

29. Kent J. T. Lectures on Homoeopathic Materia Medica. Low priced edition. B. jain publishers (p) ltd.New Delhi: 2002; 854-951.Clark J.H. A Dictionary of Practical Materia Medica. Reprint edition. Pratap Publications. 

CONQUER DECREPIT BONES – MOULD AS STURDY WITH HOMOEOPATHIC MODALITY

 ABSTRACT

Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bone has hard and solid outer shell surrounding the connecting plates and rods of bones within which lies the bone marrow, internally they are soft and spongy and thus bones are light, strong and flexible. Good health of the individual is mostly depend on strong bone and healthy skeletal makeup. There are totally 206 bones present in human body which are exquisitely and perfectly placed to keep skeleton in appropriate shape and in a healthy manner. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of this disorder.

 

INTRODUCTION

 

Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones. Osteopenia, by definition, is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.

 

AETIOLOGY & RISK FACTORS

 

· The leading cause of osteoporosis is a lack of certain hormones, particularly oestrogen in women and androgen in men. Women, especially those older than 60 years of age, are frequently diagnosed with the disease. Menopause is accompanied by lower oestrogen levels and increases a woman's risk for osteoporosis. Other factors that may contribute to bone loss in this age group include inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and other age-related changes in endocrine functions (in addition to lack of oestrogen).

· Other conditions that may lead to osteoporosis include overuse of corticosteroids (Cushing syndrome), thyroid problems, lack of muscle use, bone cancer, certain genetic disorders, use of certain medications, and problems such as low calcium in the diet.

· Women are at a greater risk than men, especially women who are thin or have a small frame, as are those of advanced age. Women who are white or Asian, especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis than other women.

· Women who are postmenopausal, including those who have had early or surgically induced menopause, or abnormal or absence of menstrual periods, are at greater risk.

· Cigarette smoking, eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors.

· Rheumatoid arthritis itself is a risk factor for osteoporosis.

· Having a parent who has/had osteoporosis is a risk factor for the offspring.

 

CLINICAL FEATURES

 

· Early in the course of the disease, osteoporosis may cause no symptoms. Later, it may cause height loss or dull pain in the bones or muscles, particularly low back pain or neck pain.

· Later in the course of the disease, sharp pains may come on suddenly. The pain may not radiate (spread to other areas); it may be made worse by activity that puts weight on the area, may be accompanied by tenderness, and generally begins to subside in one week. Pain may linger more than three months.

· People with osteoporosis may not even recall a fall or other trauma that might cause a broken bone, such as in the spine or foot. Spinal compression fractures may result in loss of height with a stooped posture (called a dowager's hump).

· Fractures at other sites, commonly the hip or bones of the wrist, usually result from a fall.

 

DIAGNOSIS

 

· A routine X-ray can reveal osteoporosis of the bone because the bones appear much thinner and lighter than normal bones. Unfortunately, by the time X-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, X-rays are not accurate indicators of bone density. Thus, the appearance of the bone on X-ray often is affected by variations in the degree of exposure of the X-ray film.

· The National Osteoporosis Foundation, the American Medical Association, and other major medical organizations recommend a dual-energy X-ray absorptiometry scan (DXA, formerly known as DEXA) be used for the diagnosis of osteoporosis. DXA typically measures bone density in the hip, the spine, and the forearm. The test takes only five to 15 minutes to perform, exposes patients to very little radiation (less than one-tenth to one-hundredth of the amount used on a standard chest X-ray), and is quite precise.

· The bone density of the patient is compared to the average peak bone density of young adults of the same sex and race. This score is called the "T score" or T-score, and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass.

- Osteoporosis is defined as a bone density T score of -2.5 or below.

- Osteopenia (between normal and osteoporosis) is defined as bone density T score between -1 and -2.5.

· It is important to note that while osteopenia is considered a lesser degree of bone loss than osteoporosis, it nevertheless can be of concern when it is associated with other risk factors that can increase the chances for developing vertebral, hip, and other fractures. In this setting, osteopenia may require medication as part of the treatment program.

 

BONE MINERAL DENSITY TESTING

 

The National Osteoporosis Foundation guidelines state that there are several groups of people who should consider DXA testing for proper diagnosis of bone health:

· All postmenopausal women below age 65 who have risk factors for osteoporosis

· All women aged 65 and older

· Postmenopausal women with fractures, although this is not mandatory because treatment may well be started regardless of bone density

· Women with any of more than 50 medical conditions associated with osteoporosis; a primary care physician can scan a patient's list of medical illnesses to determine if one of these conditions is present (see causes above)

· Women whose decision to begin treatment for osteoporosis might be aided by bone density testing to determine the presence or absence of osteoporosis or osteopenia

· The National Osteoporosis Foundation guidelines state that bone-density testing does not need to be performed if a person has a known osteoporotic fracture because the patient will be treated for osteoporosis with or without a bone-density study. In addition, bone-density testing is not appropriate if the person undergoing the test is not willing to take treatment based on the results. Therefore, if bone-density testing is done, it should be performed on people willing to take some specific action to improve their bone health based on the results.

· Bone biopsy may be useful in unusual forms of osteoporosis. It provides information about rate of bone turnover and presence of secondary forms of osteoporosis. Patient with high bone turnover usually respond to antiresorptive drugs.

 

 

 

 

MANAGEMENT

 

General 

· Lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D

· Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long it should be continued. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily for optimal health.

· Building strong and healthy bones requires an adequate dietary intake of calcium beginning in childhood and adolescence for both sexes.

 

Home Remedies

· Some of the most effective home remedies for osteoporosis include the use of beans, vinegar, spinach, milk, pineapple juice, salmon, tofu, red clover, black   cohosh, yogurt, and calcium supplements, as well as behavioral modifications, including quitting smoking, cutting back on alcohol, maintaining a healthy weight, exercising, and reducing protein intake.

· Milk - Arguably the most famous substance to help “build strong bones”, the calcium found in milk is a wonderful way to work a daily bone-boost into your diet and health regimen. A single glass of milk can represent one-quarter of the recommended daily amount.

· Lower Protein Intake - Research has suggested that human beings actually consume more protein than is necessary for a healthy life, and the excretion of protein often includes excreting [13]calcium, which compounds the problems of osteoporosis

· One of the newest findings concerning osteoporosis has to do with manganese deficiency, so ensuring a high level of that mineral can seriously help fend off bone degradation. Freshly squeezed pineapple juice is a rich source of manganese.

· Excessive consumption of calcium to prevent osteoporosis can cause other problems, like calcium deposition that leads to gout, gall stones etc. Long-term treatment with calcium supplements is not recommended because some patients develop bone spurs, kidney and gall bladder stones due to calcium deposits. Discuss with trained medical professional about diet which is suitable for age before adding any major home remedies for osteoporosis.

 

HOMOEOPATHIC MANAGEMENT

The aim of homeopathy is not only to treat osteoporosis but to address its underlying cause and individual susceptibility. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. As far as therapeutic medication is concerned, several well-proved medicines are available for osteoporosis treatment that can be selected on the basis of cause, sensation and modalities of the complaints.

Homoeopathic remedies used in low potency doses can be a great part in the quest to nourish, build, and maintain strong, healthy, vitally intelligent and flexible bones.  Homoeopathically prepared minerals in particular help us to engage the energy of the foods, herbs, and exercise we also use to build and strengthen bone. Homoeopathics used in this way might be seen as reminders to our body’s intelligent foundation which directs nourishment and growth, Homoeopathy can also be a most useful bridge when even the best lifestyle efforts are failing to work well enough and you find yourself tempted to take calcium supplements. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. Some important remedies are given below for osteoporosis treatment:

 

Indicated Remedies	Indications
Calcaria Phos	it is an excellent remedy for osteoporosis. Delicate and easily breakable bones. The bones of the head are deficient in quality and quantity. This will promote the absorption of calcium from the food that the patient takes. The bones of the neck are too small and weak to support the head which is normally large. The bones of the extremities are also weak and fragile. Stools green, undigested and offensive. No appetite, it is a bone builder and creates new blood cells. It gives general tone to the entire organism.
Calcaria Carb	remarkable medicine for osteoporosis. Promotes the absorption of calcium
Calcaria Iod	should be thought of when there is deficiency of muscles and fat in addition to deficiency of bones. Unhealthy condition of glands is always present when this remedy is indicated.
Silicea	People who need this remedy are often nervous, easily tired, very chilly, and tend to sweat at night. They have a refined or delicate appearance, and often have weakness in the spine. Their injuries are slow to heal, and they tend to have a low resistance to infection. Moderate exercise often warms the person up and improves energy.
Phosphorus	This remedy is often helpful to people who are sensitive, suggestible, imaginative, but easily tired or weakened physically. Bones may be less strong than normal, or be slow to heal after fractures. Weakness is often felt in the spine, with burning pain between the shoulder blades. People who need this remedy are often tall and thin with an easily-flushing face. A desire for refreshing foods (especially ice cream) and strong thirst for cold or carbonated drinks are other indications for Phosphorus
Symphytum	When osteoporosis is a problem, fractures often occur from mild trauma. This remedy can be useful for strengthening and healing bones when new fractures occur, and also helpful when pain persists in old, healed fractures (see Fractures).
Osteocynesine Homoeopathic calcium tablets	French and Czech teams reported beneficial effects of a complex homeopathic medicine Osteocynesine in osteoporosis in menopausal women. Women got bone density tests before and after 3- and 6-month treatment with Osteocynesine that contains homeopathic dilutions of Calcarea carbonica, Calcarea phosphorica, Calcarea fluorica and Sulphur iodatum. The follow-ups showed increase of bone density.