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Osteoporosis : Diagnosis
   
Western Medicine Chinese Medicine

Osteoporosis is an insidious disease that can remain silent for decades before the bone is weakened to the point that it sustains a spontaneous fracture. The earliest signs of osteoporosis are often associated with compression fractures of the spine characterized by an episode of acute pain in the middle to low thoracic or high lumbar region (Please see pictures). Decrease in height and appearance of a dowager's hump are reliable indicators of the early progress of the disease. Also, the patient often reports early satiety and a bloated feeling after eating only a small amount of food.


BMD testing machine
(From HK Baptist Hospital)

A bone mineral density (BMD) test is the only way to diagnose osteoporosis and determine an individual's risk for future fracture. It measures the density of the bones (bone mass) and will indicate whether medication is needed to help maintain bone mass, prevent further bone loss and reduce fracture risk. The BMD test is accurate, painless and noninvasive. It is also possible to determine the rate of bone loss and/or monitor the effects of treatment if tests are conducted at intervals of a year or more.

Criteria approved for BMD tests are summarized below:
estrogen-deficient women at clinical risk of osteoporosis.
vertebrate abnormalities on x-ray suggestive of osteoporosis (osteopenia, vertebral fracture)
primary hyperparathyroidism - abnormal function of the parathyroid glands itself which result in high level of blood calcium.
monitoring response to an FDA-approved medication for osteoporosis.

For an uncomplicated patient with osteoporosis, a laboratory work-up may be recommended in addition to a BMD test.

 

Based on four examination techniques, TCM practitioners will diagnosis osteoporosis according to its clinical symptoms and further characterize it by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have.

The common disharmony patterns of osteoporosis are:

1. Yin deficiency of the liver and kidneys
  When the body perceives that it is inadequate in bone marrow, the liver and kidney will hyper-function to compensate. This results in a relative yin deficiency inside the body. Virtual "fire" is produced and presents as heat symptoms. On examination, the tongue is red with a scanty thin fur coating. The pulse feels thready and rapid.
2. Blood deficiency and excessive dampness
  Improper functions of the spleen and stomach lead to a decline in the production of blood and bone marrow, plus an accumulation of dampness. It gives rise to a non-smooth flow of blood and qi, which in turn supply inadequate nutrients to the bones. People may feel weakness, back pain or joint pain. On examination, the tongue is pale and covered with greasy fur. The pulse sign is deep and rolling.
3. Retention of dampness and kidney deficiency
  The kidneys govern water, produce marrow, dominate the bones and manufacture blood. The kidney yang energy is the source of all heat in the body. Kidney deficiency occurs when cold and dampness evils damage the kidneys. This results in inadequate kidney essence (jing) to supply the bone marrow and causes deterioration of the bones. Symptoms can manifest as back pain and hump back. On examination, the tongue is pale and covered with white greasy fur. The pulse feels deep, thready and stringy.
4. Asthenia-syndrome of superficies and interior dampness retention
  This is a morbid condition resulting from the exposure to exogenous pathogens in a person whose organs, like the spleen and stomach, are in a hypo-functioning state. When the body accumulates lot of evils (most likely dampness and coldness), stagnation of qi flow in the meridians and the joints occurs and results in impairment of organ and bones, which leads to symptoms of sluggishness, tired and heavy limbs, and joint pain. On examination, the tongue has a white coating. The pulse sign is deep and rolling.
5. Cold in the superficies and heat in the interior
  This morbid condition results from the wind and cold evils that accumulated in the superficial regions of body has invaded interiorly and transformed into heat evil. This process manifests as both heat and cold syndromes clinically. These syndromes cause kidney damage and lead to failure supply of kidney essence (jing) for bone growth. On examination, the tongue is red and covered with white greasy fur, or yellow-colored fur. The pulse feels thready, stringy and rapid.
6. Marrow deficiency and channel bi-syndrome
  When marrow is seriously exhausted, the body skeleton loses nutrients. The accumulated evils block the channels or meridians that are the paths for transportation of nutrients and this accelerates the bone deterioration. The person presents with serious symptoms like severe bone or joint pain and bone distortion. On examination, the complexion may appear pale or dark in color. The tongue is dark red, and covered with white greasy fur. The pulse feels deep and stringy.

Click here to see development of osteoporosis from a TCM perspective

Note: If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual to see a Western doctor for further follow-up. At present, patients commonly accept Western diagnostic criteria, which may include undergoing a dual-energy x-ray absorptiometry (DEXA) scan to measure bone density and determine the presence or otherwise of osteoporosis. A reading below 2.5 standard deviations matched for age, height, weight and ethnic status indicates that osteoporosis is present.