by David Rindge, DOM, RN
“My doctors have told me that I should keep up whatever I am doing,” said my slim, 88 year old female patient. “Joan” had stopped taking Boniva, the drug prescribed for her osteoporosis when she came to our clinic over two years earlier. Since then she has treated herself at home with pulsed electromagnetic field therapy x 30 minutes daily. Laser therapy has also been administered as needed for pain at office visits over her lumbar spine and hips, where bone loss was greatest. Below are results from “Joan’s” bone density testing. When she shared them with me, she also gave me a big kiss!
By 1/30/08, approximately 3 months after beginning pulsed electromagnetic field therapy (PEMF) and laser treatment, “Joan’s” bone density had increased by 0.5% at L1-L4, the area of severe osteoporosis. By 12/11/09 she had gained another 8.8% bone density in her lumbar spine, It is important to understand that individuals with severe osteoporosis typically experience frequent, intermittent back pain due to “compression” fractures which can occur spontaneously in weakened bone. “Joan” seldom has pain these days and has reported better overall health, energy and ability to exercise.
What is osteoporosis?
Osteoporosis is “systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fracture risk.” According to estimates by the National Osteoporosis Foundation. 10 million Americans (8 million women and 2 million men) have osteoporosis, and almost 34 million more (55 percent of those over age 50) are at risk of developing it. In 2005, osteoporosis-related fractures cost $19 billion, and costs are predicted to rise to approximately $25.3 billion by 2025.
Bone Mineral Density
Twenty years ago osteoporosis was usually diagnosed only after a fracture. Nowadays “bone mineral density” (BMD) can be measured by a type of x-ray technology called dexascan. To qualify as osteoporosis, bone density must be < -2.5 standard deviations than that which is normal in a young adult of the same sex. The number itself is called a “T-score.”
“Joan’s” T-scores of -3.3 on 10/31/06 and 1/30/08 were far below the -2.5 level defining osteoporosis. -3.3 is serious bone loss. In contrast, her T-score of -2.7 on 12/11/09 two years later shows stunning improvement and is very close to the -2.5 borderline. “Joan” has continued to treat herself daily with PEMF, and, based upon her progress, it is easy to believe that her bone density will be normal or nearly so on her next dexascan in two years.
Osteopenia – Marketing a “disease” and its treatment
Osteopenia is milder bone loss described as, “Low bone mass. Defined as -1.00 to -2.49 standard deviations below the average peak adult bone mass as determined by a bone mineral density examination.” Few people had ever heard the word ‘osteopenia’ much less received treatment for it prior to 1995. Yet today millions of women worldwide are taking biphosphonate drugs because they believe their condition requires it. To learn how osteopenia became a popular medical diagnosis, visit How A Bone Disease Grew To Fit The Prescription:NPR
Normal bone formation vs. biphosphonate effects
In normal bone formation, as a matrix of new connective tissue is laid down by osteoblasts and then mineralized, old bone is removed by osteoclasts. Like in any living tissue, older cells are continually replaced by newer ones. Biphosphonates disrupt this. They suppress the resorption of old bone, inhibiting and even killing osteoclasts. Without the normal actions of osteoclasts to remove old bone, the bony tissue resulting from long-term biphosphonate use, though denser on x-ray, is often weaker, less vascular and more prone to serious adverse events such as spontaneous stress fractures, esophageal cancer and biphosphonate related osteonecrosis of the jaw (BRONJ).
In biphosphonate related osteonecrosis of the jaw (BRONJ) the maxillo-facial bones become necrotic. The effects aren’t pretty. It is ironic and sad that so much destruction is wreaked upon bones by drugs intended to strengthen them. And doubly ironic (but on positive note) that laser therapy has been shown to effectively treat the consequences of BRONJ.
“Of the 14 patients who underwent laser biostimulation, nine reported complete clinical success (no pain, symptoms of infection, or exposed bone or draining fistulas), and three improved their symptomatology only, with a follow-up of between 4 and 7 mo. CONCLUSIONS: While the results reported in this study are not conclusive, they indicate that laser therapy has potential to improve management of BON (Biphosphonate-related osteonecrosis of the jaw).”
Building bone safely and cost-effectively
Laser and pulsed electromagnetic field therapies are osteogenic – they stimulate osteoblasts to form new bone. The resulting tissue may be stronger and more flexible than the original. In contrast, biphosphonates inhibit normal breakdown of old bone.
When given a choice of new or old bone, which would you choose to have more of for yourself or your patients?
“The percentage of newly formed bone was greater in the LLLT group (57.89%) than in the control group (46.75%) (p=0.006). Conclusion: The results suggest that LLLT had a positive effect on the percentage of newly formed bone.”
“With regard to bone synthesis, laser exposure has been shown to increase osteoblast activity and decrease osteoclast number, by inducing alkaline phosphatase (ALP), osteopontin, and bone sialoprotein expression.”
“There was histological evidence of improved collagen fiber deposition at early stages of the healing; increased amount of well-organized bone trabeculae at the end of the experimental period on irradiated animals. It is concluded that LPBM (laser photobiomodulation) has positive biomodulative effect on the healing process bone defects.”
“The results of the present investigation showed histological evidence of improved amount of collagen fibers at early stages of the bone healing (15 days) and increased amount of well organized bone trabeculae at the end of the experimental period (30 days) on irradiated animals …”
“Laser irradiation had significantly accelerated bone healing at 4 weeks and 8 weeks in comparison with that at the sites not irradiated. …. Our results have confirmed the positive effect of soft laser in accelerating bone regeneration.”
Laser therapy may be administered by probe treatment, laser needle acupuncture and other methods. It may provide rapid pain relief and accelerate bone healing in specific areas targeted, even with severe bone loss. Yet whereas laser therapy is labor intensive, pulsed electromagnetic field therapy may be given over large areas, even the whole body, as an unattended treatment. PEMF may also be the most cost-effective means for home treatment in osteoporosis. Both laser and PEMF are wonderful clinical tools which, in combined treatment, may complement and enhance one another.
When laser light is given at relatively low average output powers but concentrated to achieve high intensities, it may significantly stimulate osteoblasts.
Haxsen et al compared the effects of dose and intensity of laser needles to stimulate alkaline phosphatase activity and found that once threshold was achieved, the response was logarithmic and that intensity had greater relevance than dose.
Results. Primary osteoblasts showed no induction of alkaline phosphatase activity using single laserneedle stimulation with a laser power density of 51 mW/cm², an increase of about 43% at 102 mW/cm² power density (two needles per well) and a 9-fold (!) increase at 204mW/cm² laser power density (four needle stimulation per well).
Case Study – Osteonecrosis / Morbus Osgood-Schlatter
The patient was a male, born 1993, who experienced sharp pain in the tibia during sports activity. Radiology showed necrotic alterations at the tibial apophysis, and he was diagnosed with Morbus Osgood-Schlatter.
Treatment: Laser needles were place along the tibial apophysis and treatment was given x 30 minutes daily for two weeks.
Final status after 2 weeks: Morbus Osgood-Schlatter not detectable, pain-free under exertion. Radiology: negative
To view what scientists have had to say about the effects of laser therapy to build bone and treat bone-related disease, click on:
- Bone Healing – Osteogenesis
- Biphophonate Related Osteonecrosis of the Jaw (BRONJ)
- Bone – How laser therapy and ultrasound promote repair
- Bone Healing in Diabetes
- Bone – Implant Interaction
- Epiphyseal Cartilage – Bone Lengthening
- Laser-needle therapy for spontaneous osteonecrosis of the knee
To view what researchers have reported about the therapeutic effects of electromagnetic fields to build bone and treat bone-related diseases, click on:
- Ankylosing Spondylitis
- Mandibular Osteomyelitis
- Osteoporosis – Osteopenia – Bone Healing
Some final thoughts
Anyone treated for bone loss should have a Vitamin D level assessed by the 25(OH)D test at the outset. Supplementation with higher dosages of D3 based on the results of this test is rapidly becoming the standard of care and may help your patients gain bone mass quickly. If possible, assess bone mineral density before and after a treatment series. Six months is the minimum time to expect significant change in bone density.
With good information, the right choices become easy. Teach your patients about the effects of laser and pulsed electromagnetic field therapies – and also about the negative effects of biphosphonates. Given the choice of new or old bone, which treatment do you think they will choose?
 Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M, Rocca JP, Nammour S, Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases. Photomed Laser Surg. 2008 Feb;26(1):37-46
 Kreisner PE, Blaya D, Gaião L, Maciel-Santos ME, Etges A, Santana-Filho M, de Oliveira MG. Histological evaluation of the effect of low-level laser on distraction osteogenesis in rabbit mandibles. Med Oral Patol Oral Cir Bucal. 2009 Dec 29.
 Saracino S, Mozzati M, Martinasso G, Pol R, Canuto RA, Muzio G. Superpulsed laser irradiation increases osteoblast activity via modulation of bone morphogenetic factors, Lasers Surg Med. 2009 Apr;41(4):298-304
 Márquez Martínez MEPinheiro ALRamalho LM, Effect of IR laser photobiomodulation on the repair of bone defects grafted with organic bovine bone. Lasers Med Sci. 2008 Jul;23(3):313-7. Epub 2007 Sep 20.
 Gerbi ME, Pinheiro AL, Marzola C, Limeira Júnior Fde A, Ramalho LM, Ponzi EA, Soares AO, Carvalho LC, Lima HV, Gonçalves TO, Assessment of bone repair associated with the use of organic bovine bone and membrane irradiated at 830 nm. Photomed Laser Surg. 2005 Aug;23(4):382-8
 AboElsaad NS, Soory M, Gadalla LM, Ragab LI, Dunne S, Zalata KR, Louca C. Effect of soft laser and bioactive glass on bone regeneration in the treatment of bone defects (an experimental study). Lasers Med Sci. 2009 Jun 23. [
 The induction of alkaline phosphatase by osteoblasts is associated with bone formation.
 Haxsen V, Schikora D, Sommer U, Remppis A, Greten J, Kasperk C.Relevance of laser irradiance threshold in the induction of alkaline phosphatase in human osteoblast cultures. Lasers Med Sci. 2007 Oct 31.
 Case study courtesy of Detlef Schikora, University of .Paderborn; Faculty of Science.