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Jasmine et al. World Journal of Pharmaceutical Research
MINIMIZING RISK OF POSTMENOPAUSAL OSTEOPOROSIS
THROUGH SHATAVARI – A CLINICAL STUDY
*
Jasmine Ritesh ujarathi
1
, Ritesh Ashok Gujarathi
2
1
Dept. of Prasuti tantra & Stri roga, G. J. Patel Institute of Ayurvedic Studies & Research,
New Vallabh Vidyanagar, Anand, Gujarat, India.
2
Dept. of Basic principles, G. J. Patel Institute of Ayurvedic Studies & Research, New
Vallabh Vidyanagar, Anand, Gujarat, India.
ABSTRACT
The postmenopausal period is associated with significant increase in
the incidence of age related medical conditions like cardiovascular
diseases and osteoporosis. Postmenopausal Osteoporosis is a
condition of major health importance because of its association with
fractures. Bone loss is only partly reversible. Hence treatment is
aimed at minimizing the bone loss after the age of 40.
Postmenopausal osteoporosis is a disease of ageing. Rasayana can
provide better alternative in increasing quality of life. Shatavari
(Asparagus racemosus) is a well-known female rejuvenative. Its
beneficial effect on women during fertile i.e. reproductive life is well
established. In the present clinical study Shatavari was administered
in perimenopausal and menopausal women; 6gms / day in two
divided doses with milk for 10 weeks. At the end of the study it
showed highly significant (P<0.001) changes in biochemical markers
of bone formation and bone resorption.
Key words :- Postmenopausal osteoporosis, Bone loss, Rasayana, Shatavari.
INTRODUCTION
Old age is vulnerable time for both men and women - but for women it is even more so. The
aftermath of ageing strikes women twice, because in addition to process of senility, women
suffer simultaneously from the inevitable scars of menopause. Statistical data reveal that
osteoporotic fractures are four times more common than cardiovascular stroke and can lead to
Wo
rld Journal of Pharmaceutical research
Volume 2, Issue 1, 260-265. Research Article ISSN 2277 – 7105
Article
Received on
28 November 2012,
Revised on 16 December 2012,
Accepted on 29 December 2012
*Correspondence for
Author:
*Dr. Jasmine Ritesh ujarathi
Assistant Professor
Dept. of Prasuti tantra & Stri
roga, G. J. Patel Institute of
Ayurvedic Studies & Research.
New Vallabh Vidyanagar,
Anand, Gujarat. India.
jassyleo@gmail.com,
drritesh00@gmail.com,
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Jasmine et al. World Journal of Pharmaceutical Research
permanent disability and hence can even be life threatening, thus becoming a significant
cause of morbidity and mortality.
[1,2]s
World Health Organization defines osteoporosis as a “progressive systemic skeletal disease
characterized by low bone mass and micro architectural deterioration of bone tissue, with a
consequent increase in bone fragility and susceptibility to fracture”
[3].
Osteoporosis is a
metabolic disorder, where there is imbalance between bone formation and bone resorption.
Estrogen, during the reproductive phase, prevents bone loss by conserving calcium and
inhibiting activity of osteoclasts. Beginning at the age of 30 to 40, women lose about 10% of
their bone mass per decade; with age and reduced estrogen levels, there is an increased risk of
progressive loss of bone strength.
[4]
Thus post menopausal osteoporosis is one of the most
common and disabling disease affecting women.
During the past decade, it has increasingly been perceived as serious disabling disease
needing substantial involvement of all medical sciences to develop and assess potential
treatments.
The disease postmenopausal osteoporosis is a disease of Aging and prevailing specially in
women, drug Shatavari (Asparagus racemosus) was selected to analyze its role in decreasing
bone loss and hence minimizing the risk of postmenopausal osteoporosis.
AIMS AND OBJECTIVES
1. To study the disease postmenopausal osteoporosis – as per Ayurveda and modern
concept.
2. To assess the effect of Shatavari in minimizing bone loss.
3. To see for any adverse effects of the same during the study.
4. To compare the efficacy of Shatavari with Kukkutanda twak bhasma.(bhasma prepared
from egg shell)
MATERIALS AND METHODS
Clinical Study
Patients : For clinical study, patients attending OPD and IPD of I. P. G. T & R.A. hospital
presenting risk factors for developing the disease were registered.
Drugs : Shatavari moola churna, Kukkutanda twak bhasma and placebo tablets (wheat flour)
were prepared in the pharmacy of Gujarat Ayurved Univeristy, Jamnagar.
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Jasmine et al. World Journal of Pharmaceutical Research
PLAN OF STUDY
CRITERIA OF SELECTION
1. Women of age group 40 -60 years (perimenopausal and postmenopausal age group)
2. Presenting one or more risk factors for developing osteoporosis.
CRITERIA OF EXCLUSION
1. Hyperparathyroidism 2. Chronic diseases
INVESTIGATIONS
Routine blood, urine and stool examinations.
Biochemical bone markers
Urine – 24 hour urine calcium , Urine creatinine
Serum – Serum calcium, Serum alkaline phosphatase, Serum acid phosphatase
X-ray spine
CRITERIA OF ASSESSMENT
Subjective criteria
Results of the treatment were assessed on the basis of relief in Asthikshayatmaka lakshana
(symptoms of Asthi Dhatu Kshaya) with the help of specific scoring pattern as recorded in
research proforma.
Objective criteria
To assess the effect of treatment on bone loss, biochemical bone markers were used before
treatment (BT) and after treatment (AT) to detect any change in rate of bone formation and
bone resorption.
Table I- Grouping
GROUP A GROUP B GROUP C
DRUG
Kukkutanda
Twak bhasma
Shatavari
Moola churna
Placebo
(Wheat flour)
DOSE
500 mg / day
in 2 divided doses
6 gm / day in
3 divided doses
6 gm / day in
3 divided doses
DURATION
10 Weeks 10 Weeks 10 Weeks
ANUPANA
Milk Milk Milk
No. of Patients
10 14 11
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Jasmine et al. World Journal of Pharmaceutical Research
Table II - Observations
Group No. Of Patients
Total Registered Lama Completed
A 14 04 10
B 15 01 14
C 14 03 11
TOTAL 43 08 35
1. Maximum no. of patients – 62.79% belonged to the age group of 40-45 years.
2. 55.81% of patients were postmenopausal, whereas 44.81% fell into perimenopausal age
group.
3. 83.72% of patients registered had natural menopause whereas 16.27% underwent
hysterectomy.
4. 34.88% of patients had age of menopause between 40-45 and 45-50 years.
5. 67.44% of patients did not perform any exercise in their daily routine.
6. Vata dominant Prakriti was found maximum number of patients with combination of
Pitta (58.13%) and Kapha (32.55%)
7. 95.34% of patients had low life time calcium intake as risk factor, 69.76% presented
small body frame as well as inactive life style whereas 48.83% were underweight and
34.88% of patients had early menopause as risk factor for developing osteoporosis.
8. Bone pain and low back pain was observed in 95.34%, extreme fatigue and cramps in
legs in 90.69%, difficulty in walking in 88.37%, premature graying of hair in 67.44% and
pain at symphysis pubis was observed in 60.46% of patients.
9. Radiological findings indicated established osteoporosis in 18.60% of patients. Loss of
normal lumber lordosis was found in 23.25% of patients.
RESULTS
Table III – Subjective Parameters
Asthi
Kshayatmaka
Lakshana
GROUP A
Kukkutanda
twak bhasma
GROUP B
Shatavari
moola churna
GROUP
C
Placebo
Keshapatan 66.66% 85.29% 37.50%
Asthi vedana 57.69% 80% 36.36%
Shrama 50% 71.42% 33.33%
Sandhishoola 36.84% 70.37% 32.14%
Katishoola 33.33% 68.57% 30.43%
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Jasmine et al. World Journal of Pharmaceutical Research
Table IV – Objective Parameters
BIOCHEMICAL
BONE MARKERS
GROUP A GROUP B GROUP C
Bone Formation Non significant Highly significant
( P < 0.01)
Non significant
Bone resorption Significant
(P < 0.05)
Highly significant
( P < 0.01)
Highly significant
( P < 0.01)
TOTAL EFFECT OF THERAPY
In group A, marked improvement was found in 10% of patients, 30% of patients were
moderately improved and 60% patients showed mild improvement in lakshana of asthi
kshaya. No patient remained unchanged in this group.
In group B, marked improvement was found in 50% patients. 42.85% patients were
moderately improved, 7.14% showed mild improvement and none of the patient remained
unchanged.
In group C, 22.85% of patients presented marked improvement, 28.57% patients exhibited
moderate improvement, mild improvement was demonstrated in 54.54% patients and 36.26%
of patients remained unchanged after administration of therapy.
DISCUSSION
Reviewing all the available literatures related to Asthi Dhatu, the final diagnosis of the
disease was given as ‘Asthi Saushirya.’ Anga bhanga- fractures can be considered as
Pratyatma lakshana of this disease. Gambhira dhatu, Svabhavabalapravritta Vyadhi and
Bhedawastha make this disease Asadhya. This disease can become Yapya by intervention at
proper level, following Pathyapathaya and Rasayana Therapy.
Maximum patients registered had early menopause and had less than 2 years as duration of
menopause which supports the fact that age of menopause is declining and that the bone loss
is accelerated in the first few years of menopause. Low life time calcium intake and inactive
life style were the risk factors found in maximum number of patients which serves as Nidana
(Etiological factors) of Asthi Saushirya.
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Jasmine et al. World Journal of Pharmaceutical Research
Effect of Shatavari on Asthi Ksayatmaka lakshana was better over that of KTB and placebo.
The effect of Shatavari on bone markers indicates that it enhances bone formation as well as
decreases bone resorption. Shatavari acts on both ways and balances bone remodeling and
hence can prevent bone loss and help in increasing bone mass. The mode of action of
Shatavari can also be explained with the help of its active chemical constituent – Steroidal
Saponins which fall under Phytoestrogens. Phytoestrogens stimulate osteoblastosis and
suppress osteoclastosis and thus help in preventing bone loss.
CONCLUSION
Postmenopausal osteoporosis is a disabling disease which renders women a bedridden life.
Hormone replacement therapy- only known therapy in prevention and management of
postmenopausal osteoporosis has got major risks than benefits.
The effect of Shatavari on Asthi Kshayatmaka lakshana was better over Kukkutanda twak
bhasma and placebo. Shatavari provided encouraging results on bone metabolism by
preventing bone loss and enhancing bone formation.
Additional studies by combining Shatavari with calcium supplements and life style planning
are needed to improve the quality of life of postmenopausal women.
REFERENCES
1. Melton L J, Chrischilles E A, Cooper C, Lane A W, Riggs B L. How many women have
osteoporosis ? J Bone Miner Res; 7 : 1005-1010, 1992
2. Riggs BL, Melton LJ III. Involutional Osteoporosis. N Engl J Med ; 314:1676-86,1986.
3. World Health Organisation. Assessment of fracture risk and its application to screening
for postmenopausal osteoporosis. Geneva : WHO, 1994. (Technical report series 843)
4. Heaney RP, Recker RR, Savile PD. Menopausal changes in bone remodeling. J Lab Clin
Med; 92 : 964-70, 1978.