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The Use of Osteopathic Manipulation to Facilitate Bone Remodeling in a Postmenopausal Osteoporotic Woman

Journal: The Journal of the American Osteopathic Association Date: 2020/12, 120(12):Pages: e24-e25. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2020.157/html)

Keywords:

bone remodeling [3]
female [628]
menopause [15]
OMT [3776]
osteopathic manipulative treatment [3796]
osteoporosis [27]
pilot study [196]
pretest posttest design [221]
women [583]

Abstract:

Statement of Significance: In this pilot study, we investigated the efficacy of OMT in the treatment of osteoporosis by monitoring OSCAL and SNTX. We hypothesized that OMT could help facilitate the bone remodeling process and be used in conjunction with established therapies to maintain or increase BMD in a postmenopausal 60-year-old osteoporotic female. Whereas conventional WBE is an active process, OMT is rather passive, enabling treatment in patients with physical limitations. We used two common techniques; seated articulatory technique and pedal pump. We hypothesized that OMT would induce a significant change in OSCAL and SNTX- demonstrating a positive effect on the bone remodeling process in our sixty-year-old postmenopausal osteoporotic volunteer. Research Methods: Twelve biweekly treatments consisting of seated articulatory technique and a vigorous pedal pump were administered in an outpatient facility. Since bone deposition occurs in proportion to compressional load, the seated articulatory technique would introduce both a rotary and translatory force into the thoracic vertebrae (T1-T12). Similarly, the pedal pump would create axial compressive force and aid in lymphatic drainage throughout the lower body. Per session, the seated articulatory technique was performed for five minutes and the pedal pump was performed for ten minutes. We used OSCAL and SNTX as measures for bone remodeling. Baseline laboratory values were obtained prior to the start of the treatment period and after the six-week treatment. Data Analysis: Analysis of this pilot study indicates that OMT induced a significant increase in SNTX and a negligible change in serum OSCAL. We are currently in the process of replicating this study on a larger scale in order to address limitations inherent to the study's design and sample size. Results: SNTX measures were significantly increased compared with baseline, while there was no significant change in OSCAL. Prior to treatment, OSCAL and SNTX were 23 ng/mL and 4.0 nM BCE/L, respectively. Following treatment, OSCAL was 21 ng/mL and SNTX was 15.2 nM BCE/L. Conclusion: Increased SNTX is consistent with bone remodeling. We hope to investigate the lack of OSCAL change in our follow up study. We believe it is possible that OMT could provide synergism in the bone remodeling process. We hope to repeat this protocol with a larger cohort and measure osteoclastic and osteoblastic activity via additional markers of bone remodeling such as PTH, vitamin D, calcitonin, and confirmative densitometry. The results of this study demonstrate the need for collaboration in the osteopathic community to facilitate both the investigation and application of “passive mechanotransduction” to replicate the remodeling benefits associated with weight-bearing activities.


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