Embargo Date: May 26, 2005, 5:00 a.m. ESTMay 26, 2005, The American Journal of Medicine, Volume 118, No. 6The American Journal of Medicine (2005) 118, 569 –570 EDITORIAL Viagra: The risks of recreational use Viagra (Sildenafil) has become one of the most com-Zoloft, and acetaminophen. Since sexual activity is asso-monly prescribed and abused pharmaceuticals availableciated with sign
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Pemf treatment for osteoporosis“Electromagnetic field treatment for Osteoporosis”.
WHAT IS OSTEOPOROSIS.
The currently accepted definition of osteoporosis is “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 risk”.
Bone mineral can be measured with reasonable accuracy and precision.
These tests form the basis for diagnosis of osteoporosis and the prediction
of fracture risk.
Bone mass refers to the amount of bone tissue contained in the skeleton.
Bone mass can be expressed in terms of bone mineral content (the total
grams of bone mineral within a given area of bone) or in terms of bone
mineral density (the bone mineral content normalized for the projected
Normally bone density peaks between the ages of 30 to 40 and in
subsequent years the bone density decreases.
If the decrease is significant enough, the so called “fracture threshold” is
At this level of bone density the patient is at significant risk of fracture.
These thresholds are reached at different ages and the extend of bone loss
varies depending on the peak bone mass and generic and environmental
factors, including activity level and diet.
The decrease of bone density in post-menopausal women is significantly
greater than in pre-menopausal women or men. The average annual bone
loss in post-menopausal women is 1% - 2% and in men 0.2% - 0.5%.
Although the rate of bone loss in women is the highest in the years after
the menopause, it continues in many patients for many years and
increases again after the age of 70. Annual losses can even reach 3% -5%
during the first years following the menopause.
In women the major cause of bone loss and osteoporosis is estrogen
withdrawal, most commonly associated with the menopause and
declining ovarian function, but any cause of estrogen deficiency can
cause bone loss.
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. In men, androgen might play a role in causing osteoporosis. Here progressive loss of bone starts around the third decade and continues during life. There are many conditions other then estrogen or androgen deficiency that cause bone loss, including malignancies, metabolic abnormalities, gastrointestinal diseases and exposure to certain drugs. Also smoking and excessive use of alcohol may contribute to bone loss. A study group of the World Health Organization (WHO) has proposed diagnostic guidelines for interpretation of bone mass measurement in Caucasian women. Bone density values in individuals are expressed in relation to a reference in Standard Deviation (SD) units. This reduces the problems associated with differences between the various measuring instruments, it does however require defined “normal” ranges. If bone mineral density (BMD) is below 1 SD but not below 2.5 SD of the mean value of peak bone mass in young normal women, than there is a low bone mass (Osteopenia). If this value is greater than 2.5 SD below this value the patient has Osteoporosis. This definition is definitely not perfect but reasonable well for diagnostic and therapeutic considerations. Osteoporosis is a-symptomatic until a fracture occurs. The risk of fracture is inversely related to bone mass. As bone mass decreases, the risk of fracture increases. Even relatively small alterations in bone mass can lead to significant changes in the risk of fractures. The most common sites of fracture in osteoporotic patients are the vertebrae, the hip, and the forearm. Osteoporotic fractures are associated with significant morbidity and mortality. The most important complaint of patients with osteoporosis is acute or intermittent back pain following normal activity. The pain usually lasts a few days or weeks and then subsides. Such episodes recur and may result in chronic backache. The episodes are due to crush fractures of vertebrae. As the disease progresses, loss of height, spinal deformity and fractures occur. _____________________________________________________________________
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Hip fractures, in particular, frequently have grim prognosis.
The mortality rate of osteoporotic hip fractures is between 15 % and 20
%, primarily due to pulmonary emboli, pneumonia, and other
complications of surgery and prolonged hospitalization. The lifetime risk
of hip fractures in white women is as great as the risk of breast,
endometrial and ovarian cancer combined. One half of patients who
survive a hip fracture are unable to walk unassisted and 25 % are
confined to nursing homes. In up to 20 % of hip fractures the patient dies
within 6 months.
A GROWING HEALTH PROBLEM.
Osteoporosis is a major and growing health problem worldwide.
It affects an estimated 75 million people in the United States, Europe and
Japan, including a large amount of men. One-third of women over 65 will
have vertebral fractures and 90 % of women over the age of 75 have an
evidence of osteoporosis.
The enormity of this health problem when considering the increasing
population of elderly people in the world is contrasted by the present
therapeutic difficulties in significantly adding bone and improving bone
strength once it has been lost.
Osteoporosis will become an even more serious public health problem.
Osteoporosis related fractures can be expected to double during the next
5 decades. It is also expected that the occurrence of osteoporosis in men
In order to be able to diagnose osteoporosis it is necessary to measure the
patient's bone density. A number of techniques are available for this
Single- and Dual Photon Absorptiometry.
Single photon absorptiometry (SPA) was initially developed in 1963.
This technique involves passing a focused beam of radionuclide radiation
across the arm. Because radiation is blocked more by denser tissue (bone)
than by soft tissue, bone density can be deducted from these differences.
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Disadvantage of this technique include the requirement for uniform soft
tissue around the bone to be measured. In addition it is not possible using
this technique to measure bone density of hip and spine, being the sites
more vulnerable to fractures.
SPA has provided however important population based information in
epidemiological studies, specifically on the effects of aging of the
A more sophisticated version of the same technology used in
SPA is dual photon absorptiometry (DPA).
It was developed in the early 1970s. The first systems became
commercially available in 1980.
DPA uses an radioactive isotope, which emits radiation at two different
energy levels, instead of the single energy level used for SPA
While the body is scanned, the two energy levels are detected and used
for mathematical calculations to obtain different values for the different
amounts of transmissions of the energy through the body. By using this
method more accurate bone density values are obtained.
Single Energy X-ray Absorptiometry.
Instead of using a radio nuclide photon source as in SPA an X-ray source
is used in Single Energy X-ray Absorptiometry (SXA). This method can
however not been used at spine and hip.
Dual Energy X-ray Absorptiometry.
In 1987 Dual Energy X-ray Absorptiometry (DXA or DEXA) was
introduced. Today DXA equipment is widely available and this method is
the choice for bone density measurements.
The basic technique of DXA is essentially the same as in DPA except that
the radionuclide source is replaced with an X-ray source. DXA has
several advantages over the older absorptiometry methods. Measurements
take less time, expose the patient to less radiation and most important the
results of the measurements are more precise. With the development of
p-DXA technique it became now possible to measure reasonable accurate
the density of the forearm, both mid-distal and ultra-distal during the
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Radiographic Absorptiometry.
Bone density is determined from X-ray films by reference to a metal
calibration wedge placed alongside the hand during a X-ray procedure.
Radiographic densitometry is then used to correlate to bone density
measurements. This technique is however outdated.
Quantitative Computed Tomography.
Quantitative Computed Tomography (QCT) represents a modification of
conventional CT scanners.
The image produced by CT is generated by computer analysis of
numerous X-ray transmission values obtained in different directions. The
X-ray source and detector rotate around a patient in a fixed plane. From
these CT scans bone density is calculated by reference to the density of
Radiation exposure is substantially higher than the other bone density
measuring techniques. This form of measurement is useful in elderly
patients who may have age-related osteoarthritis and aortic calcification
interfering with absorptiometric measurements.
During the last few years various new machines have been introduced for
the assessment of skeletal status.
By means of Quantitative Ultrasound (QUS), measurements are
performed at patella, heelbone, tibia, and ulna.
Mainly the Broadband Ultrasound Attenuation (BUA) and Velocity or
Speed Of Sound (SOS) are calculated. The systems yield quantitative
results averaged over the measurement area the Quantitative Ultrasound
Index (QUI) and some calcaneal systems generate also an image.
Ultrasound systems have the advantage of obtaining information without
the need for ionizing radiation, however in comparison, the amount of
radiation emitted by modern p-DXA systems is extremely low. Main
reason for purchasing an ultrasound system is the lower price and
portability of these devices compared with p-DXA machines.
Long term studies of QUS changes over time are still limited. Expressing
measurement results on a percentage level is misleading because of the
different units and calibrations employed. Studies indicate that
standarized precision errors of QUS approaches, are at least two times
larger compared to corresponding DXA results.
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Since this technique is not deriving absolute data on bone mineral
density, QUS can be used only for fracture risk prediction.
Chemical measurements of blood and urine by biochemical screening
assays (bone markers) are used to evaluate bone resorption and formation.
Although biochemical screening assays have improved over the last few
years, they still have an accuracy error of up to 30%.
They are only useful for studying bone turnover in large groups of
patients where individual errors are statistically compensated.
Chemical analyses such as urinary hydroxyproline and pyridinoline
crosslinks or serum alkaline phosphatase cannot be used to diagnose
osteoporosis. Most of the time they cannot be used to evaluate an
imbalance between formation and destruction of bone. They are however
useful to determine bone turnover and consequently to identify those
patients who are likely to be fast bone losers.
Given the magnitude of the problem of fractures with associated reduced
life expectancy, quality of life and last but not least the enormous costs
for healthcare providers involved, the most logical approach is
Bone is continuously turned over by modeling and remodeling, the rates
of which are under hormonal influence.
There are some indications that the higher the rate of bone turnover, the
higher the rate of bone loss.
If women with a high turnover lose more bone over a prolonged period of
time, they should eventually sustain more fragility fractures.
Low calcium intake is a risk factor for fracture especially in advanced
age. Beyond the age of 70 it correlates with low bone mineral density.
Since calcium absorption lowers with age, the danger of negative balance
increases with age.
By assuring sufficient calcium intake, the prognosis of osteoporosis might
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Low calorie and low calcium and low protein intake are related to low
bone mass density and increases fracture risk.
Also low vitamin D levels are related to low bone mass density
specifically in the hip. Vitamin D deficiency is frequent in the elderly,
specifically in residents of old age and nursing homes, where nutritional
intake and the amount of sunlight may be insufficient.
After the age of 70, mobility decreases twice as much as general health.
Physical activity is of high importance for bone mass density in the
Bone specific drugs.
Calcium and Vitamin D have no significant long term effects.
Additional intake of fluorides was thought to be effective to increase bone
density. Recent studies have however shown that the effects are no
different from calcium and vitamin D for the prevention of fractures in
osteoporotic patients. It might even result in less flexible bone structures
and thus actually increase the fracture risk.
Anabolic steroids have been used for many years in the treatment of
They probably act mainly by inhibiting bone resorption. They continue
only to be of interest for the elderly with advanced disease due to their
side effects in long term use.
Calcitonin inhibits bone resorption and may reduce fracture frequency.
However since calcitonin mainly acts on trabicular bone (the spongy
bone) its effect on bone mass density can not be established. Its
effectiveness on the hip bone is thus questionable.
Biphosphonates (Clodronate, Alendronate, Etidronate, Olpadronate,
Pamidronate, Risedronate, Tiludronate, Ibandronate, Zoledronate) act by
inhibiting bone resorption. They decrease the speed of bone loss and
fracture frequency. They do have substantial side effects and long term
safety profiles of biphosphonates are yet to be established.
One of the most prominent drugs in the Alendronate group is a very
expensive drug (Fosamax), hard to use, rough on stomach and throat,
including ulceration and bleeding.
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Hormone Replacement Therapy (HRT & ERT). Estrogens are widely used for post-menstrual osteoporosis treatment. Specifically the psychological benefits (relieves hot flashes) and their possible protection against cardiovascular diseases, is attractive. However it might be necessary to use them throughout life. They are poorly accepted by women over 70 years. If discontinued after prolonged use accelerated bone loss will occur. Selective Estrogen Receptor Modulators (SERM) produces both estrogen-agonistic effects on bone and lipid metabolism and estrogen-antagonistic effects on uterine endometrium and breast tissue. BONE SPECIFIC DRUGS
increase fracture risk Response post-menopausal women is low No long term effect Prevalence of toxicity bone Secondary resistance Must be monitored in urine Absorption problems Abdominal pain Long term safety not established Stays in body for life Very expensive Protection against cardiac events If stopped rapid bone loss Needs to be taken all life? New drugs for osteoporosis will require fundamental advances of knowledge in this field. The current most widely used treatments drugs were developed essentially without fundamental in depth understanding. Estrogen, biphosphonates and calcitonin are mainly used therapeutically as bone resorption inhibitors. _____________________________________________________________________
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd.
The calcified mass of adult bone has three types of surface.
1. A surface on which nothing seems to happen. This includes about 90 2. A surface on which bone is being formed. 3. A surface at which bone is being resorbed. Bone formation and bone resorption go on continuously and simultaneously throughout life, though the rates change with age and vary in different parts of the skeleton. Osteoporosis occurs when bone resorption is greater than bone formation. Bone formation comprises two steps, the laying down of the extracellular matrix and the deposition therein of bone salt. The dynamic processes of formation and destruction of bone are under cellular control. Bone formation is controlled by single nuclear cells called Osteoblasts, and bone resorption by multinuclear giant cells called Osteoclasts. Bone is a specialized connective tissue in which a matrix consisting of collagen fibres, a large variety of other proteins and ground substance is impregnated with a solid mineral. The bone matrix is responsible for the resistance of bone to tractional and torsional forces. The collagen forms more than 25 % of the bones and is synthesized by osteoblasts. On the bone surface collagen fibres are normally arranged in concentric rings of hard calcified matrix. The bone minerals provide to the bone compressive strength and rigidity. It contains the mineral salts hydroxyapetite and calcium. In addition there are small amounts of magnesium hydroxide, fluoride and sulphate. As these salts are deposited in the framework formed by the collagen fibres of the matrix, crystallization occurs and the tissue hardens. This process is called calcification or mineralisation. Both the concentrations of ions of calcium and phosphate in the extracellular fluid maintain crystallization. If the concentration is not adequate the tissue will not be hard enough resulting in increased bone fracture risk. _____________________________________________________________________
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. There are two types of bone structure: cortical (compact) bone and
trabecular (spongy) bone.
Cortical bone is more dense and constitutes of 80 % of the skeletal mass
and forms the external layer of all bones in the human body.
Trabecular bone consists of lamellae arranged in an irregular latticework
of thin plates of bone and helps long bones to resist the stress of weight
placed on them.
The process by which bone forms is called ossification.
Bone forms either by the mineralisation of cartilage or directly by
osteoblasts in a collagenous matrix.
During the first two decades of life bone grows, followed by
consolidation and reaching its peak value around thirty five years. After
this peak, bone loss starts. Nutritional factors, especially calcium intake,
the level of physical activity and generic factors are important in
determining the peak bone mass.
When a bone is fractured, it heals with bone. Bone is the only solid tissue
in the body that can replace itself.
Bone healing is simple when it occurs smoothly, complicated when it
does not. The process is being initiated by stimuli from the bone itself.
Fractures through bone with a good blood supply, surrounded by muscle
and without soft tissue trauma, have an excellent chance of healing, but
fractures at the middle of long bones, particularly with extensive soft
tissue damage, have a high incidence of non-union.
ELECTRO-MAGNETIC FIELD TREATMENT.
Selected low-energy time-varying electromagnetic fields have been used
during the past 15 years to treat un-united fractures (non-unions). More
than 100,000 patients, mainly in the USA, have been treated.
Retrospective studies have substantiated their biological effectiveness in
Bone is responsive to the mechanical demands placed on it. When loading
diminishes, as it does during bed rest, immobilization and weightlessness,
bone mass is lost.
On the other hand when loading is increased correctly, bone mass
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Results of bio-mechanical and histologic investigations prove that electromagnetic fields not only prevent bone loss, but also restore bone mass, once lost. A program was set up at McGill University of Montreal, where was found that electro-magnetic fields damp bone resorption activity. Furthermore prove was found that selected electro-magnetic fields increase bone formation. The resorption of bone is lowest and formation of new bone greatest, when energy of the imposed fields is concentrated in the lower frequency components. These results are consistent with other studies showing, that cells respond to a broad spectrum of frequencies. They appear to be most sensitive to frequencies in the range of those produced endogenously, that is in the range of 1000 Hz or less. Tissue dosimetry studies show that the frequency response of cortical bone over a range of 100 Hz to 20 kHz show a steep roll off between 100 and 200 Hz. Electro-magnetic fields at specific frequencies have shown to produce osteogenic effects in a turkey ulna model. Furthermore low-amplitude signals decrease bone resorption in a canine fibular model. Lifestyle factors like malnutrition, smoking, excessive use of alcohol and a sedentary lifestyle contribute to, and worsen, osteoporosis. It is not known whether this response derives from decreased osteoblastic activity, increased osteoclastic resorption, or both. Elderly persons can heal fractures in normal intervals, showing that osteoblasts can be activated by appropriate stimuli. A pilot study at the Pacific Health Research Institute in Honolulu was designed to provide concrete data on the restoration of bone mass in post-menopausal females. A total of 20 subjects between 57 and 75 years, all with decreased bone mineral density as defined by a bone densitometer, were treated during a period of 12 weeks. After a period of 6 weeks the bone density rose in those patients with an average of 5.6%. Electromagnetic fields do modify biological behavior by inducing electrical changes around and within the cell. The key to rational use of electro-magnetic fields lies in the ability to define the specific treatment parameters (amplitude, frequency, orientation and timing). _____________________________________________________________________
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd. Various studies have clearly shown that bone density does increase in osteoporosis-prone patients exposed to specific pulsed electromagnetic fields. Properly applied pulsed electromagnetic fields, if scaled for whole body use, have clear clinical benefits for treatment of osteoporosis. _____________________________________________________________________
“Electromagnetic field treatment for Osteoporosis”. Ben Philipson Curatronic Ltd.
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