Osteoprotective effects of Cimicifuga racemosa and its triterpene-saponins are responsible for reduction of bone marrow fat.

PURPOSE: Elderly people often develop visceral obesity accompanied by osteoporosis. Visceral adipocytes secrete a number of adipokines and cytokines which augment the development of arteriosclerosis and type 2 diabetes. Bone marrow fat cells also secrete these pro-inflammatory cytokines which stimulate osteoclast and inhibit osteoblast activity. Ovariectomized (ovx) rats also develop general and bone marrow obesity and osteoporosis both of which can be partially prevented by estradiol (E2) and the special extract of Cimicifuga racemosa (CR) BNO 1055. Whether this extract or the thereof isolated triterpene-saponins or polar substances can also prevent bone marrow obesity and thereby the development of osteoporosis was compared with the effects of estradiol (E2). METHODS: Rats were ovx and fed with food containing either CR BNO 1055 or its triterpene-saponin or polar constituents or with E2 for 4 weeks. Histomorphometry and STRUT analyses were applied to histological preparations to determine the amount of trabecles, hematopoietic and fat tissue in the bone marrow. RESULTS: Ovx rats lost significant amounts of trabecular BMD, surface and nodes while the number of free trabecular ends and fat load in the marrow increased. This was totally prevented by E2 and partially by CR BNO 1055 and the triterpene-saponin but not by the polar fraction. High serum osteocalcin and CrossLaps levels were reduced by E2 and the S-fraction. CONCLUSIONS: It is well established that E2 prevents osteoporosis. It is also known that CR BNO 1055 does not contain estrogenic substances. CR BNO 1055 and the triterpene-saponin-fraction reduced the development of osteoporosis most likely by a reduction of the bone marrow fat load and possibly by reducing the secretion of pro-inflammatory cytokines. Hence, the triterpene-saponin-fraction may serve as a basis for a new osteoporosis preventing preparation also in human patients.

Cimicifuga racemosa and its triterpene-saponins prevent the Metabolic Syndrome and deterioration of cartilage in the knee joint of ovariectomized rats by similar mechanisms.

PURPOSE: An unphysiologic accumulation of fat cells in many parts of the body including abdomen and joints results in increased production of pro-inflammatory cytokines which have adverse effects on serum lipids, glucose and on joint cartilage. The special extract of Cimicifuga racemosa CR BNO 1055 was shown to reduce the size of the abdominal fat depot. It was therefore tempting to test whether this extract, its saponin and its unpolar and polar fractions S- and R-fraction respectively (no quotation) also reduce fat depots and fat cell accumulation in a fat depot located in the lower hind leg (called paratibial fat depot = PFD), in joint fat pads (in the knee joint this is called Hoffa's fat pad) that occur in response to ovariectomy and whether this was accompanied by reduced serum lipids, glucose and improved cartilage features in the knee joint. METHODS: Rats (n = 10/group) were ovariectomized (ovx) and fed with CR BNO 1055, S- or R-fraction containing food (average intake 8.2, or 2.05 or 7.07 mg/day/animal) for 4 weeks. Ovx rats kept under no additive-containing food served as controls. The sizes of the PFD, of Hoffa's fat pad and of the cartilage thickness of the knee joints were determined by quantitative computer tomography and histomorphometrically. In the serum cholesterol, leptin and glucose levels were measured. RESULTS: High load with fat tissue in the PFD and in the knee joints was present in the ovx rats. Treatment with CR BNO 1055 and its S-fraction reduced fat load of both, Hoffa's fat pad and of the PFD significantly and this resulted in reduced body weight which was significant under CR BNO 1055. Fat load in the PFD correlated significantly with the height of serum leptin and cholesterol. The fat load in the knee joint correlated inversely with the size of knee cartilage tissue. CONCLUSIONS: High fat load of the body increases following ovx and this causes increased serum leptin, cholesterol and glucose levels. Following ovx the size of Hoffa's fat pad increases also significantly and this has adverse effects on knee cartilage tissue. Therefore, increased fat tissue in joints appears to belong to the Metabolic Syndrome. This effect can be largely prevented by CR BNO 1005 and its S- but not by its R-fraction. Hence, the saponins in CR BNO 1055 may be useful in preventing the Metabolic Syndrome and osteoarthritis.

The significance of laboratory testing for the German diagnosis-related group system--the systematic evaluation of comorbidities of relevance to case reimbursement and continued development of the DRG Watchdog software.

The launch of the G-DRG system version 2004 made it necessary to update our former studies on the importance of laboratory testing (Clin Lab 2002;48:327-333). Using a systematic search algorithm, we established a total of 2,828 comorbidities, the ICD coding of which has a positive effect on case reimbursement, thus helping to secure hospital revenue. 62% of these comorbidities were found to depend exclusively or predominantly on laboratory testing. On average, one such comorbidity can be said to influence approximately 100 DRGs (range 2 to 226). In order to gain a clearer idea of the practical benefit of such "hits", amounting to several 100,000s, we selected about 5% of them for illustration with a computer program called DRG Watchdog. This program shows just how much additional reimbursement can be achieved for a specific DRG upon the ICD coding of a specific comorbidity. The program is freely available on the Internet at www.trillium.de and enjoys more than 100 search runs per day.