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JKM > Volume 42(2); 2021 > Article
Won, Choi, Lee, and Lee: Improvement of Low Bone Mineral Density Treated with Jeopgol-tang in a Middle-Aged Man: A Case Report

Abstract

Bone mineral density (BMD) is a major diagnostic marker for bone health. A 44-year-old male had BMD of 0.81 g/cm2 (Z-score: −3.1) in lumbar spine scan and 0.54 g/cm2 (Z-score: −2.7) for femoral neck from regular medical checkup in Apr 2020. He had no other specific medical conditions except hyperlipidemia and alcohol was a single risk factor for fracture according to Fracture Risk Assessment Tool. After he was diagnosed with liver-kidney deficiency and treated for 20 weeks with Jeopgol-tang originally patented for promoting fracture recovery, lumbar spine BMD increased by 13.6 % (0.92 g/cm2, Z-score: −2.1) and femoral neck BMD by 22.2% (0.66 g/cm2, Z-score: −1.8) compared with those of Mar 2020. Herbal medicine treatment for tonifying liver and kidney to improve BMD warrants further investigation.

Fig. 1
Timeline of the Case
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Table 1
The Results of Thyroid Function Test, Common Blood Counter and Biochemistry
Result Reference range
Thyroid test

 TSH 1.013 0.35 – 5.5 uIU/mL
 FT4 1.20 0.89 – 1.76 ng/dL

CBC
 Hemoglobin 14.6 13 – 17 g/dL

Liver function test
 AST 24 < 40 U/L
 ALT 31 < 41 U/L
Renal function test
 BUN 13.5 5 – 20 mg/dL
 Creatinine 0.7 0.5 – 1.2 mg/dL
Electrolytes
 Calcium 9.7 8.6 – 10.0 mg/dL
 Phosphorus 3.9 2.5 – 4.5 mg/dL

The above tests were performed in August 2019.

Table 2
Changes of Bone Mineral Density and Other Risk Factors
March 2018 April 2020 September 2020
Age 41 43 44

Body weight (Kg) 91.9 93.8 93.8

Height (cm) 179.4 179.2 179.2

Body mass index (Kg/m2) 26.8 29.2 29.2

DXA results
 L1 BMD (g/cm2) 0.68 0.63 0.77
 L2 BMD (g/cm2) 0.83 0.73 0.89
 L3 BMD (g/cm2) 0.90 0.91 0.98
 L4 BMD (g/cm2) 0.95 0.92 1.00
 L1-L4 BMD (g/cm2) 0.85 0.81 0.92
 L1-L4 Z-score −2.7 −3.1 −2.1
 Femoral Neck BMD (g/cm2) 0.67 0.54 0.66
 Femoral Neck Z-score −1.7 −2.7 −1.8
 Femoral Neck T-score −2.2 −3.1 −2.2

Risk factors associated with FRAX
 Previous fracture - - -
 Parent fractured hip - - -
 Current smoking - - -
 Glucocorticoids - - -
 Rheumatoid arthritis - - -
 Secondary osteoporosis - - -
 Alcohol 3 or more units/day Yes Yes Yes

FRAX results
 The 10-year Probability of Major Osteoporotic Fractures 5.9% 13% 6.0%
 The 10-year Probability of Hip Fractures 2.8% 9.1% 2.7%

BMD, bone mineral density; DXA, dual X-ray absorptiometry; FRAX, fracture risk assessment tool; L, lumbar spine. One whose Z-score of BMD is lower than −2.0 is considered to have low BMD for his/her age. The 10-year probabilities of major osteoporotic and hip fractures were calculated following the way of FRAX® (web version 4.2; University of Sheffield, UK) using T-score of femoral neck bone BMD measured with DXA and risk factors (i.e., sex, age, weight, height, history of previous fragile fracture, parent fractured hip, and oral administration of glucocorticoids, present illness of rheumatoid arthritis and disorders associated with osteoporosis, current smoking, and daily consumption of 3 alcohol units or more). This patient had only one risk factor, i.e., daily consumption of 3 alcohol units or more.

Table 3
Composition and Daily Dose of Jeopgol-tang
Herbal name Medicinal herb name Weight (g)
當歸 Angelica gigas 20
川芎 Cnidium officinale 20
黃嗜 Astragalus membranaceus 8
人蔘 Panax ginseng 8
枸杞子 Lycium barbarum Linné 8
蔓蔘 Codonopsis pilosula 8
續斷 Dipsacus asperoides C. Y. Cheng et T. M. Ai 4
石斛 Dendrobium nobile Lindley 4
補骨脂 Psoralea corylifolia 4
兎絲子 Cuscuta chinensis 4
鹿茸 Cervus elaphus Linné 4

Jeopgol-tang was orally administered twice daily in the form of water-based decoction (120 mL once).

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