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Improvement of Low Bone Mineral Density Treated with Jeopgol-tang in a Middle-Aged Man: A Case Report

Article information

J Korean Med. 2021;42(2):90-97
Publication date (electronic) : 2021 June 01
doi : https://doi.org/10.13048/jkm.21018
Jiyoon Won1,2orcid_icon, Youngjin Choi3orcid_icon, Byung-Cheol Lee4orcid_icon, Hyangsook Lee1,2,orcid_icon
1Department of Science in Korean Medicine, College of Korean Medicine, Graduate School, Kyung Hee University
2Acupuncture and Meridian Science Research Center, Kyung Hee University
3KyungheeDabok Korean Medicine Clinic, Kyung Hee University
4Department of Nephrology and Endocrinology, College of Korean Medicine, Kyung Hee University
Correspondence to: Hyangsook Lee, College of Korean Medicine, Kyung Hee University, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Korea, Tel: +82-2-961-0703, Fax: +82-2-963-2175, E-mail: erc633@khu.ac.kr
Received 2020 December 31; Revised 2021 March 26; Accepted 2021 April 6.

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.

Keywords: Jeopgol-tang; osteoporosis; osteopenia; bone mineral density; bone health; FRAX; case report
Fig. 1

Timeline of the Case

The Results of Thyroid Function Test, Common Blood Counter and Biochemistry

Changes of Bone Mineral Density and Other Risk Factors

Composition and Daily Dose of Jeopgol-tang

References

1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993;94(6):646–50.
2. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994;843:1–129.
3. Mauck KF, Clarke BL. Diagnosis, screening, prevention, and treatment of osteoporosis. Mayo Clin Proc 2006;81(5):662–72.
4. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B. Mortality after osteoporotic fractures. Osteoporos Int 2004;Jan. 15(1):38–42.
5. Ha YC, Kim TY, Lee A, Lee YK, Kim HY, Kim JH, et al. Current trends and future projections of hip fracture in South Korea using nationwide claims data. Osteoporos Int 2016;27(8):2603–9.
6. Kim J, Lee E, Kim S, Lee TJ. Economic Burden of Osteoporotic Fracture of the Elderly in South Korea: A National Survey. Value Health Reg Issues 2016;9:36–41.
7. Kanis J. Assessment of osteoporosis at the primary health-care level Technical Report: WHO Collaborating Centre University of Sheffield; 2008. [cited Nov 2020]. Available from: http://www.shef.ac.uk/FRAX .
8. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014;25(10):2359–81.
9. Mikyas Y, Agodoa I, Yurgin N. A systematic review of osteoporosis medication adherence and osteoporosis-related fracture costs in men. Appl Health Econ Health Policy 2014;12(3):267–77.
10. Zhao JG, Zeng XT, Wang J, Liu L. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA 2017;318(24):2466–82.
11. Liu Y, Liu JP, Xia Y. Chinese herbal medicines for treating osteoporosis. Cochrane Database Syst Rev 2014;(3):CD005467.
12. Yun G, Kang J, Lee H. Effects of Korean herbal medicine (Cheong-A-Won) for treatment of bone mineral density in women with osteoporosis: A randomized, double blind, placebo controlled trial. Eur J Integr Med 2018;20:84–9.
13. Guide publishing group of Korean society for bone and mineral research. Physician’s guide for osteoporosis Seoul: Cdmthebig; 2018.
14. Department of kidney internal medicine. Kidney Internal Medicine Seoul: Gunjachulpansa; 2015. p. 116–20.
15. Lee H, Hahm D, Kim H, Sohn B, Hwang D, Choi Y, eds. The effect of Jeopgol-tang on recovery of bone fracture in Sprague-Dawley rats. The Annual Conference of Traditional Korean Medicine; 2006;
16. Lee H, Hahm D, Kim H, Sohn B, Choi Y, DSH . Crude drugs composition for accelerating recovery of bone fracture 10-0731160. 2007;
17. Leutner M, Matzhold C, Bellach L, Deischinger C, Harreiter J, Thurner S, et al. Diagnosis of osteoporosis in statin-treated patients is dose-dependent. Ann Rheum Dis 2019;78(12):1706–11.
18. Hong S, You S. A study of prevalence and related risk factors of osteoporosis for employees. JKIECS 2013;8(4):631–7.
19. Han G, Kim S. What Cases Are Worth Publishing in the Korean Medical Case Report? Korean J Acupunct 2020;37(3):159–71.
20. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. J Med Case Rep 2013;7:223.
21. Fitzpatrick LA. Secondary causes of osteoporosis. Mayo Clinic proceedings 2002;77(5):453–68.

Article information Continued

Copyright © 2021 The Society of Korean Medicine all rights reserved

Fig. 1

Fig. 1

Timeline of the Case

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).