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International Journal of Complementary & Alternative Medicine

Review Article Open Access

An updated review of single herbal drugs in the
management of osteoporosis
Abstract
Volume 11 Issue 2 - 2018
Osteoporosis is a bone disease characterized by a decrease in bone mass and micro‒
architectural alterations. This would lead to a bone with less tensile strength and significantly Shubhashree MN,1 Raghavendra Naik,2
more susceptibility to fracture with less force. This syndrome is clinically silent but
Doddamani SH,1 Sulochana Bhat3
progressive, usually only noted when a fracture occurs. Though there is no direct reference 1
Research Officer (S‒2), Regional Ayurveda Research Institute
of this condition in classical texts of Ayurveda, it can be correlated with the Asthi kshaya
for Metabolic disorders, India
on the basis of pathophysiology and symptoms. For the management of this condition, 2
Research Officer (Ay), Regional Ayurveda Research Institute for
various therapeutic measures are recommended in the classical texts. Among them, single Metabolic disorders, India
herbal remedies for the management of osteoporosis are in routine clinical practice. The 3
Research Officer (S‒3), Regional Ayurveda Research Institute
present review has been carried out to compile different pre‒clinical and clinical research for Metabolic disorders, India
works reported on single herbal drugs for the management of osteoporosis. Analysis of
results shows that, about 11 different drugs mentioned in classical texts of Ayurveda are
Correspondence: Shubhashree MN, Research Officer (S‒2),
reported for their anti‒osteoporotic properties in different clinical and experimental studies.
Regional Ayurveda Research Institute for Metabolic disorders
Clinically Nigella sativa is reported for its effect on the bone markers of postmenopausal (RARIMD), Govt Central Pharmacy Annexe, Near Ashoka Pillar,
women, Plants like Withania somnifera, Cissus quadrangularis, Punicagranatum, Jayanagar, Bangalore, Karnataka, India, Tel 9448 0169 68,
Tinospora cordifolia, are studied experimentally and found effective in the management Email shubhathejas@gmail.com
of osteoporosis. The findings of present review highlight the use of these single and simple
herbal remedies for the treatment of patients suffering from osteoporosis and can give a lead Received: August 18, 2017 | Published: March 27, 2018
to further extensive research on these drugs.

Keywords: Asthikshaya, Ayurveda, herbal drugs, medicinal plants, osteoporosis

Introduction better remedy for the management of osteoporosis. Therefore the
present review has been made to compile the single herbal drugs
Osteoporosis is the most common metabolic bone disorder reported for their beneficial effect on osteoporosis and to present them
characterized by decreased bone strength. It is a major problem of in a single place.
health care delivery services, both in the developed and developing
countries. According to WHO, osteoporosis is a “progressive Material and methods
systemic skeletal disease characterized by low bone mass and micro
architectural deterioration of bone tissue, with a consequent increase Different herbal drugs reported for their effect on management
in bone fragility and susceptibility to fracture.1 This is a heterogeneous of osteoporosis were compiled from published research articles. The
cluster of abnormal processes characterized by the net loss of bone. available data is arranged according to their Sanskrit name, English
It results in a decrease in total mineralized bone without a decrease in name, botanical identity and part used. The mechanism of action of
the ratio of bone mineral to the organic matrix.2,3 As a result, there is a reported drugs is analyzed critically and presented systematically.
decrease in the overall amount of bone.
Results and discussion
In Ayurvedic classical literature, there is no direct reference
Analysis of data reveals that, about 11 different drugs mentioned
regarding osteoporosis and its management. Acharya Sushruta4 has
in classical texts of Ayurveda are reported for their anti‒osteoporotic
explained about Asthikshaya where the causative factors, signs and
properties in different clinical and experimental studies (Table 1).
symptoms are similar to osteoporosis. Different Acharya like Charaka5
Clinically Nigella sativa is reported for its effect on the bone markers
and Vagbhata6 have opined the same.
of postmenopausal women. Different parts of the plants like Withania
Prevalence of this disease is increasing as the population of elderly somnifera, Cissus quadrangularis, Punica granatum, Tinospora
is on a rise. It is estimated that as many as 1 in 2 women and 1 in 5 men cordifolia, Curcuma longa, Nigella sativa, Melia azedarach,
are at risk for an osteoporosis‒related fracture during their lifetime.7 Asparagus racemosus, Moringa oleifera, Zingiber officinale and
Because of increase in ageing population, it is estimated that by the Sesamum indicum are studied experimentally and found effective in
year 2020, the number of women affected will be double.8 Thus, this the management of osteoporosis.
condition has assumed major public health importance in recent years.
It has been estimated that spinal compression fractures are associated Ashwagandha‒Withania somnifera (L.) wunal
with osteoporosis and 15 to 34% of all patients with hip fractures will Effect of Withaniasomnifera root ethanolic extract has been
die from complications within 6months.9 evaluated for anti‒osteoporotic activity in ovariectomized Sprague‒
Though different treatment modalities like HRT, Calcium & Vit‒D Dawley rats. Extract at the dose of 65 mg/kg for 16 weeks has shown
supplement are commonly used, there is no treatment which has a significant increase in serum alkaline phosphatase levels and urinary
satisfactory improvement without side effects. Due to some adverse calcium and phosphorus excretion. Histological findings has revealed
effects and lacunae of synthetic drugs, there is a need of finding out narrowed, and disappearance of trabeculae with widened medullary
spaces in the ovariectomized group.10

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15406/ijcam. differentiation of cells into osteoblastic lineage and increased the mineralization of bone like matrix on both the osteoblast model Anti‒osteoporotic activity of ethanolic extract of Punica granatum systems used in the study. bone density and bone bone loss in ovariectomized rats. daily for 90 days showed significant 500 and 750mg/kg per day showed a definite antiosteoporotic effect. (Moringaceae) Aerial parts tree Shunthi Ginger Zingiberofficinale Roscoe (Zingiberaceae) Rhizome Tila Sesam Sesamumindicum L.00372 . increase in serum calcium. the proliferation. Indian Guduchi Tinosporacordifolia (Thunb. 83 Table 1 Single herbal drugs reported for their effect on osteoporosis Sanskrit name English name Botanical identity Part used Winter cherry. The anabolic steroidal Guduchi‒Tinospora cordifolia (thunb. weight and density. (Vitaceae) Aerial parts Dadima Pomegranate Punicagranatum L.12 increase in uterine weight.17 Consumption of calcium compared to control. Indian Ashwagandha Withaniasomnifera (L. (Lythraceae) Fruit Gulbel. (Meliaceae) Bark Wild Asparagus. DOI: 10.) Dunal (Solanaceae) Root Ginseng Asthishrinkhala Edible stemmed wine Cissusquadrangularis L.) miers component of Asthishrunkhala showed a marked influence in the rate of fracture healing by influencing early regeneration of all Effects of alcoholic extract of Tinospora cordifolia on the connective tissues of mesenchyme origin. (Pedaliaceae) Seeds Asthishrunkala‒ Cissus quadrangularis l. osteoclastic activity. It mobilizes fibroblast and chondroblasts to an injured tissue and enhances regeneration. ALP activity. femur BMD and femur hardness.18 The alcoholic extract of fruit peel at the dose ethanol extract of Cissus quadrangularis at two different dose levels of of 500mg/kg and 750mg/kg. increased levels of calcium and phosphorus in serum and reduced bone loss. IND‒HE and estrogen treatment increased mineral content of calcium. Cell morphology studies clearly indicated in ovariectomized rat model of osteoporosis at 100. ovariectomized mice. (Zingiberaceae) Rhizome Krishna jiraka Black cumin Nigella sativa L. 300 and 500 mg/ the increase in cell numbers and absence of adverse change in the cell kg is reported experimentally. creatinine and phosphorous levels were significantly decreased. in vitro model system for human osteoblasts (human osteoblast like Citation: Shubhashree MN.19 Exposure of different reduced the osteoclastic activity there by facilitating bone formation concentrations (10‒100μg/ml) of the ethanolic extract on osteoblastic in experimental animals.21 Aqueous and alcoholic length. et al. Results of Histopathology studies indicated that IND‒HE (75 in bone mineral density and bone micro‒architecture impairment in and 100mg/kg) prevented bone loss. tartrate resistant acid phosphatase. On histology data shown significantly increased serum estradiol.13 Asthishrunkhala contains anabolic and cells showed characteristic morphological changes and increment in phytogenic steroids like Ketosteroids. progress with increased ossification.20 promotes good bone health. Int J Complement Alt Med. The extract at a dosage of 25μg/ml stimulated the growth of osteoblasts. These effects were described in hardness in ovariectomised in rats. There was significant increase in femur morphology on treatment with the extract.11 In another experimental study. and 200 mg/kg significantly prevented significant increase in bone thickness. alpha ampyrone and tetracyclic triterpenoids. alpha amayrin. In The petroleum‒ether extract at the dose of 500mg/kg. as evidenced by the weight gain in femur. (Asparagaceae) Tuberous root Sparrow grass Moringa. osteocalcin whereas urine calcium. Shatavari Asparagus racemosus Willd. serum vitamin D3 and serum that fraction could increase osteoblast number. Histology of femur exhibits restorative The phytoestrogen‒rich fraction (IND‒HE) from aerial parts of C. A significant growth in cell proliferation. (Ranunculaceae) Seeds Nimba Neem Meliaazedarach L. dependent manner suggested that extract has a stimulatory effect on Ketosteroid acts as antagonists to the glucocorticoid receptor and osteoblastic bone formation or potential activity against osteoporosis. An updated review of single herbal drugs in the management of osteoporosis. drumstick Shigru Moringaoleifera Lam. and also significant decrease in urine were observed.2018. Alkaline phosphatase was significantly pomegranate peel extract was able to significantly prevent the decrease reduced.14 These anabolic and collagen contents and matrix mineralization of osteoblasts in a dose steroidal components showed a marked influence on fracture‒healing. Copyright: An updated review of single herbal drugs in the management of osteoporosis ©2018 Shubhashree et al. cell number. namely the fibroblasts. 100. mineralization and increased quadrangularis has shown presence of phytoestrogen‒rich fraction.11(2):82–86.15 osteoblast cells isolated from femur of rats.) Miers (Menispermaceae) Stem Tinospora Haridra Turmeric Curcuma longa L.16 Polar fraction of Punica granatum (L) peel Treatment with IND‒HE (75 and 100mg/kg) showed statistically extract at the doses of 50.11. sitosterol. phosphorus and extracts were evaluated for osteogenic effect using a widely employed reduction in alkaline phosphatase. differentiation and mineralization of bone like matrix chondroblasts and osteoblasts involved in the healing and quicker was studied on human osteoblast‒like cells MG‒63 and primary mineralization of the callus. Doddamani SH. Naik R. increased the Dadima ‒ Punica granatum l. 2018. for 3 months addition.

similar to estrogen and produce antiosteoporotic effect. characterized by reduced bone mass and osteoporotic fracture.22 Probably with excessive loss of calcium in urine.37 Treatment hormone treatment. Phytosterols and other active constituents present in the root of Asparagus racemosus may effect on estrogen receptor Haridra Curcuma longa l.39 of M. while the fruit extract was having more elaborative ovariectomized induced loss of trabecular bone and also preserved the effect as it increased ALP activity. the root extracts ratio. property. Conclusion Methanolic and aqueous extract obtained from Asparagus Osteoporosis is the most common metabolic bone disorder racemosus root has shown significant effect on mineralization. including osteoporosis.11(2):82–86. diseases.. The proliferation of osteoblasts at a dosage of 25µg/ml but. The osteoprotective effect was comparable with activation of Akt‒GSK3β signalling.00372 . significant alteration of serum alkaline phosphatase activity. mineral density. The test drug failed to cause any significant changes in the osteoblast like cells with increased transcription levels of osteogenic bone markers levels.26 bone marrow derived mesenchymal stem cells as demonstrated by increased alkaline phosphatase staining and alkaline phosphatase Krishna jeeraka ‒Nigella sativa linn. DOI: 10. ovariectomized rats showed significant Shunti‒ Zingiber officinale roscoe decrease in plasma Ca+2. All the extracts were found bone protective micro architecture and biomechanical properties of the femur in male in streptococcal cell wall induced arthritis.2018. the aqueous extract significantly reduced serum alkaline phosphatase activity. ash percent and ash calcium content were obtained. The osteo‒protective effects of structurally‒related polyphenols MDA. could be used as medicines for osteoporosis. Furthermore. These data provide experimental estradiol. it has been reported that. It was observed that ethanolic extract stimulated weight. but did not affect proliferation of both osteoblasts resistant acid phosphatase activity in ovariectomized rats. phosphate. increased number and connectedness of the strut‒like trabeculae. bioactive phenolic curcuminoids was evaluated for bone‒protective Flower and fruit were found to have significant osteoblast stimulating effects in a hypogonadal rat model of postmenopausal osteoporosis. Significant increase in total ash Citation: Shubhashree MN. accompanied by a significant increase in plasma ALP.33 Regenerative with curcumin was able to reverse all the ovariectomy‒induced effect of Moringaoleifera extract on haematological parameters deteriorations. Doddamani SH.34 Ethanolic extract able to reduce the osteoclast number but also increase the osteoblast at the dose of 600 mg/kg. et al. Curcumin has been reported to affect osteoclastogenesis and osteoblast proliferation and activity In an in‒vivo study. extract s inhibited osteoclast proliferation and induced apoptosis by up‒regulation of caspase activity and increase of mitochondrial pro‒ In an experimental study. upregulated ALP enzyme activity.31 microarchitecture.29 In a clinical study. and enhanced mineralized to these postmenopausal women. This ossification and osteoclastic activity suppression were observed condition seriously hampers the quality life of individual and needs in histopathological examination.15406/ijcam. and evidence supporting the clinical use of curcumin for prevention or 300ng/ml enhanced osteogenic differentiation capacity of porcine treatment of osteoporosis. These changes were reversed by (gingerols) isolated from the rhizomes of Z. preventing bone mineral diabetic rats to a level equivalent to that achieved with parathyroid density loss as determined by dual energy absorptiometry. lytic bone trabeculae and improved bone cultured primary bone marrow cells. 2018. effects of Nigella sativa with 6‒gingerol stimulated osteoblast differentiation in normal and supplements was evaluated on the bone markers of postmenopausal inflammatory settings.32 Curcumin is considered as a potential treatment in numerous Shigru– Moringa oleifera lam. activity. methanolic extracts of Moringaoleifera in vitro. An updated review of single herbal drugs in the management of osteoporosis. significantly reduced urinary calcium count. TNF‒α and IL‒6. nitrates.23 Extracts prepared from Curcuma longa L. feeding of 10% sesame oil reduced apoptotic proteins expression. the fermented form of medication is recommended for parameters including hardness of 4th lumbar vertebra. So. Int J Complement Alt Med. extract showed no influence on cell proliferation.28. serum tartrate resistant acid phosphatase activity. Flower extract was found to be increasing the number of The curcuminoid‒enriched turmeric prevented up to 50% of osteoblastic cells. containing components showed a positive effect on osteoblast cell line SaOS2.35 Ethanolic extract of leaves at the dose of 100. 200. This compound induced the differentiation of women. The high dose of curcumin treatment was not only and bone marrow of adult Wistar rat is reported.40 Shatavari‒ Asparagus racemosus willd. when supplemented for the duration of 3 months markers. It also improved biomechanical this insight. 84 cells SAOS‒2).25 Curcumin administration ameliorates oxidative stress‒induced excretion and significantly increased calcium content of bones in apoptosis in osteoblasts by preserving mitochondrial functions and ovariectomised rats. calcium. amino terminal collagen type 1 telopeptide. urinary excretion of Nimba ‒Melia azadirech linn. Copyright: An updated review of single herbal drugs in the management of osteoporosis ©2018 Shubhashree et al. The Tila‒ Sesamum indicum linn. officiale was reported supplementation of test drug.30 The sample size of the study was nodule formation.38 Oil extract of garlic possibly has a of bone markers at several time points and any changes in the bone positive role in suppressing ovariectomy induced bone resorption. azedarach. hydroxyproline and urinary calcium to creatinine In an in vitro study. It also reduced the degree of inflammation in only 15 and the duration of study was not longer to obtain the readings TNF‒a‒treated MG‒63 cells.24 Treatment hydroxyproline content and bone mineral formation. The test and chondrocytes. The osteo‒inducible effect was also observed in drug also reduced disruptive. Naik R.36 In an experimental study. a long term study with larger sample size may Garlic oil extract supplementation prevented ovariectomy‒induced give more convincing results. and its weight. the extracts enhanced the significantly altered alkaline phosphatase activity and tartrate differentiation. The extract also serum calcium and also inhibited the ovariectomized induced elicited pro‒stimulatory effects on osteoblasts. femoral length therapeutic purposes in Ayurveda.11. induced bone formation.27 Nigella sativa seed oil improved the in experimental studies.

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