Lingram and colleagues¹ conducted a study to assess the effect of Cissus quadrangularis in accelerating bone healing in order to rehabilitate the patient as early as possible. The investigators correlated the serial values of serum calcium, serum phosphorus, and parathyroid hormones with process of fracture healing. Eighty patients of uncomplicated bone fracture, divided into 2 groups of 40 patients each, were included. Group A received C. quadrangularis for 30 days while Group B was given starch capsule.

Mean serum human parathyroid hormone (hPTH) in Group A was 26.78 ± 9.06, 29.30 ± 9.44, 51.60 ± 9.28 and 34.90 ± 7.43 at baseline, 7^th, 21^st and 31^st day, respectively. Mean serum hPTH in Group B was 30.78 ± 7.51, 37.15 ± 14.57, 32.95 ± 8.95 and 29.20 ± 7.47 on the respective days (Fig. 1). Serum PTH was significantly increased in group A in comparison with group B. Mean serum calcium in Group A was 9.59 ± 0.60, 9.58 ± 0.53, 9.49 ± 0.54 and 9.61 ± 0.57 at baseline, 7^th, 21^st and 31^st day, respectively. The respective values were 9.48 ± 0.57, 9.49 ± 0.62, 9.63 ± 0.58 and 9.34 ± 1.78 in Group B (Fig. 2). In Group A, serum calcium showed marked elevation between 3^rd and 4^th week - the critical period for bone mineralization and maturation. In group B, at this time, serum calcium declined. Mean serum phosphorus in Group A was 3.85 ± 0.80, 3.72 ± 0.76, 3.96 ± 0.73 and 3.66 ± 0.62 at baseline, 7^th, 21^st and 31^st day, respectively. In Group B, the levels were 3.89 ± 0.62, 3.94 ± 0.87, 3.99 ± 0.82 and 3.95 ± 0.81, respectively.

A higher percentage of patients in Group B required concomitant medication in comparison with Group A (Fig. 3). On day 31, mean change of Visual Analogue Scale (VAS) in Group A was 9.87 ± 0.33 compared to 9.27 ± 0.45 in Group B, which suggested reduction in pain in group A compared to Group B. Additionally, in Group A, there were no adverse events while in Group B, 17.5% patients had common adverse events like mild abdominal pain/epigastric pain due to use of excessive concomitant drugs.

C. quadrangularis was shown to be a potential agent that can accelerate bone healing. The group treated with C. quadrangularis showed elevation pattern of serum hPTH, early initiation of bone resorption with early initiation of osteoblast activity besides continuous bone maturation, giving way to expedited hardening of callus at fracture site. This may reduce the healing period or immobilization period which may lead to early rehabilitation. C. quadrangular is also has analgesic activity and can reduce the requirement of analgesic drugs used in fracture management.

Reference

1. Lingram RP, Yeshwant RS, Popatrao NH, et al.Biochemical and hormonal evaluation of Cissus quadrangularis in accelerating healing process of bone fracture: A clinical study. Int J Res Ayurveda Pharm. 2014;5(4):461-9.

1: Baseline; 2: Day 7; 3: Day 21; 4: Day 31

1: Baseline; 2: Day 7; 3: Day 21; 4: Day 31