Identification of the defining clinical characteristics of a silent disease in patients meeting the WHO Criteria of Osteoporosis(Asthisaushirya): An Ayurvedic Perspective on its clinical diagnosis and management- A Pilot Study

Osteoporosis has been described as a ‘silent disease’ in modern literature. Just as other silent diseases like Hypertension and Hypercholesterolemia are identified by their terminal events of Stroke and CAD respectively, Osteoporosis is also identified by the occurrence of fragility fractures in the spine, hip and wrist in their natural history.[i] To circumvent the occurrence of such medical emergencies in these ‘silent diseases’, modern medicine evolved and recommends routine screening of vulnerable age groups with blood pressure (BP), lipid profile and bone mineral density (BMD) measurements.

 Osteoporosis is an anukt vyadhi (undescribed disease) in classic Ayurveda texts, though there are few references available in Brihattreyi Samhitas by the name of Asthisaushirya. Whereas Acharya Charak has described ‘Sushirta of Asthidhatu’ (porousness of bone) as a physiological process to make space for the Majjadhatu to rest in (Ch. Chi 15/31); Acharya Vagabhat, on the other hand, has alluded to a pathological process wherein Asthisaushrya has been described as one of the lakshanas (signs) of a clinical syndrome called Majjagata Vata (A.H.Su.11/19; A.H. Ni. 15/12). However, the Samhitas are silent about the clinical presentation of Asthisaushirya and there is no mention of clinical characteristics which can help the clinician to identify this lakshna in a patient.

 A review of the contemporary Ayurveda literature over the last 40 years on various search portals revealed that researchers on the subject have tended to equate Osteoporosis with Asthisashirya and have considered the vitiation of Vata in Asthi and Majja Dhatus (Asthimajjagata Vata) as the main Samprapti of the disease. While equating Osteoporosis with Asthisaushirya, the other associated signs and symptoms described along with Asthisaushirya in the relevant shlokas, such as severe pain, sleeplessness, falling of teeth, hairs, and nails etc. have been largely ignored by the workers. Clearly, these researchers are not describing the silent disease Osteoporosis which has a set WHO criteria of BMD ≤ 2.5. Thus, their equation of these two terms Osteoporosis and Asthisashirya is not justified in the light of the present clinical and literary evidence.

Apropos of the discussion above, and on the strength of their clinical experience, the researchers of the present study believe that Osteoporosis has been labelled a ‘silent disease’ not because it is silent, but because the modern clinical methods employed to read the symptomatology of this disease were not sensitive enough. Hence, the need for identifying the defining clinical characteristics of this silent disease in patients meeting the WHO criteria of Osteoporosis, employing the more subtle clinical methods described in classic Ayurveda texts, is strongly felt. The proposed study is a small step in that direction and is also expected to establish the clinical presentation of Asthisaushirya.

 

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