Cannabis and Orthopaedics

 The bones that make up the human skeleton need to be strong and flexible as they form the framework that houses and protects vital soft organs, as well as providing the anchor for muscles, tissues, nerves, blood and skin. Inside the bones are the factories for new cell generation. Bone health, nourishment and regeneration are vital for human health. Improper diet, lack of exercise, aging, etc., result in degradation of bone health. Reduced bone density and strength results in brittle bones, fractures and breakages. With growing age, bone damage takes longer to heal. In fact, it is quite common for an elderly person to suffer a major bone breakage resulting from a fall. This often takes such a toll on the elderly person, that recovery is difficult, and the person drifts from being bedridden to death relatively quickly, if lucky, or slowly and painfully, if unfortunate. Other bone related conditions that afflict persons are arthritis at the joints.

Recent studies have shown promise in terms of cannabis usage promoting the regeneration of bones and helping to increase bone density, strength and flexibility. A study says that "CBD alone makes bones stronger during healing, enhancing the maturation of the collagenous matrix, which provides the basis for new mineralization of bone tissue." Recent studies also show cannabis is beneficial in the treatment of osteoporosis, symptomatic relief in lumbar compression fractures, and that cannabinoid receptors CB1 and CB2 are expressed in bone and regulate bone homeostasis, thus promoting bone healing. Cannabis is also known to help with inflammations from arthritis and injuries. These conditions often reduce a person's mobility, thus resulting in a further weakening of the skeletal structure. Studies show that cannabis is beneficial for spinal cord injuries. 

 

The use of cannabis as an analgesic is helping increasing numbers of people to reduce, or eliminate, the amount of opioids that they would otherwise consume as they recover from injuries to their bones. In Report Of The Indian Hemp Drugs Commission, 1893-94, regarding the medical uses of cannabis in 19th century India, the following information is to be found - ' 462. In connection with the therapeutics of hemp drugs, one of the commonest uses is for the relief of pain, the drugs being used either as local or general anodynes...A small fragment of charas is placed in a carious tooth to relieve toothache...One witness states that hemp drugs are used as a substitute for opium...The tincture of Cannabis has been used as a local anæsthetic in extracting teeth (British Journal of Dental Science).'

 

Cannabis and the hops that go into beer emerged from the same humulus plant millions of years ago. We all know the benefits of calcium rich beer in strengthening the bones. It could be the same mechanism at work with cannabis. Chemical analysis in 19th century India on cannabis samples from various parts of India indicate high calcium content. The Indian Hemp Drugs Commission reports that - 'Oxalate of calcium was present in all the samples and accounted for the large quantity of calcium carbonate present in the ashes. The larger the amount of solid aqueous extract in the drug, the higher was the proportion of the organic acid; but this rule is interfered with when sugar occurs in the extract.'  

 

Cannabis reduces nausea and increases appetite so that persons suffering from bone damage can get adequate nourishment. Given that cannabis users have a more active lifestyle, less obesity and diabetes, bone strengthening activities are also subsequently more a part of a cannabis user's health. Also studies show no increase in periodontal disease through the use of cannabis.

As more information is available, multinational personal care giants are entering the picture. Cosmetics-Design EU reports that 'Personal care giant Colgate-Palmolive has developed three active oral care formulas that integrate a cannabinoid, namely cannabidiol (CBD), for antibacterial efficacy and anti-inflammatory action.'

The increased contamination of our air, water, food and soil through the use of chemical pesticides and fertilizers and the use of petrochemical based synthetic products have resulted in damage to our bone health in complex, and often, unknown ways. In Rachel Carson's Silent Spring, she says "In the early 1920s women who painted luminous figures on watch dials swallowed minute amounts of radium by touching the brushes to their lips; in some of these women bone cancers developed after a lapse of 15 or more years. A period of 15 to 30 years or even more has been demonstrated for some cancers caused by occupational exposures to chemical carcinogens." Since the time that the book was published nearly 60 years ago, the amount and varieties of these dangerous synthetic chemical compounds in our environment have only increased. World wide, governments continue to subsidize and promote the use of these dangerous chemical compounds on large scales. Legalization of cannabis offers diverse ways to reduce the use of petrochemical based synthetic chemical compounds, including the use of chemical herbicides, pesticides and fertilizers. Then there are the synthetic pharmaceutical drugs, some of which cause serious damage to the bones from long term usage. Cannabis offers many ways to reduce the usage of these toxic medicines.

The number of studies seem relatively few at this point in time but they hold promise for the future. As the older age group populations are more eagerly embracing cannabis in their large numbers, and as more studies focus on bone health, we should be seeing more information on the interaction between cannabis and the skeletal system. 

 

Related articles

The following list of articles taken from various media speak about the above subject. Words in italics are the thoughts of yours truly at the time of reading the article. 

More than one in five patients with chronic musculoskeletal pain (MSK) report having used cannabis to manage their symptoms and 90 percent of them perceive it to be effective, according to data published in the Journal of Cannabis Research.

Canadian researchers surveyed 629 patients with chronic MSK pain. Twenty-three percent acknowledged having used cannabis therapeutically. Over 90 percent of consumers said that it was either “very,” “somewhat,” or “slightly” effective at managing their pain, improving their sleep, and reducing anxiety-related symptoms. More than half (57 percent) perceived cannabis to be more effective than other analgesic medications, and 40 percent acknowledged decreasing their use of traditional pain medications following their use of cannabis.

The study’s authors concluded: “One in five patients presenting to an orthopaedic surgeon with chronic MSK pain are using or have used cannabis with the specific intent to manage their pain, and most report it to be effective. … Future double-blind placebo-controlled trials are required to understand if this reported efficacy is accurate, and what role, if any, cannabis may play in the management of chronic MSK pain."

https://norml.org/news/2024/07/18/survey-patients-say-cannabis-effectively-treats-their-musculoskeletal-pain/

Researchers reported, “Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73 percent from baseline pain at the 180-min time point.” Side-effects associated with CBD were “minimal.”

Authors concluded: “This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain. … This novel study can catalyze the use of CBD as an alternative analgesic to opioids for acute inflammatory pain conditions, which could ultimately help to address the opioid epidemic.

https://norml.org/news/2023/11/16/clinical-trial-oral-cbd-administration-provides-relief-from-dental-pain/

'Cannabidiol demonstrates bone-protecting activity in both cellular and animal models of osteoporosis, according to preclinical data published in the journal Calcified Tissue International.

Researchers affiliated with New York University’s Grossman School of Medicine investigated the effects of CBD in vitro using human osteoprogenitor cells and in vivo via a murine femur fracture model.

They reported that human cells pre-treated with CBD showed significantly higher levels of osteocalcin – a bone-producing hormone. They also reported that CBD-pretreated mice exhibited more rapid bone healing than controls.

“Collectively, these in vitro and in vivo findings suggest that CBD exerts cell-specific effects which can be exploited to enhance bone metabolism,” authors concluded. “These findings also indicate that CBD usage in an osteoporotic population may positively impact bone morphology, warranting further research.”'

https://norml.org/news/2023/04/27/cbd-administration-prevents-osteoporosis-in-preclinical-models/

'Twenty-five percent of respondents acknowledged either using or having used CBD for symptom control. Nearly half (46 percent) of users reported that it mitigated their pain. Thirty-three percent said that the use of CBD improved sleep and 20 percent said that it reduced their anxiety. By contrast, nearly 25 percent of users reported no therapeutic benefits from CBD.'

https://norml.org/news/2021/08/12/survey-many-patients-with-spine-related-pain-turning-to-cbd

'Results
CBD demonstrated bi-phasic effects on HDPCs viability in tested concentrations. We found CBD significantly promoted cell migration, enhanced collagen synthesis and mineralized deposits in HDPCs when treated by 1 µM CBD supplemented in the differentiation media. RT-PCR revealed CBD-induced increased the expression of angiogenic and odontogenic genes, such as DSPP, DMP-1, OPN, ALP, Runx2, VEGFR1 and ICAM-1. These effects were via MAPK activation in a manner mainly mediated by CB2.

Conclusion
The results from this study suggested that CBD can induce odonto/osteogenesis from HDPCs and has the potential to develop new therapeutics in VPT in dentistry.'

https://www.sciencedirect.com/science/article/abs/pii/S0300571221000944

'Personal care giant Colgate-Palmolive has developed three active oral care formulas that integrate a cannabinoid, namely cannabidiol (CBD), for antibacterial efficacy and anti-inflammatory action. '

https://www.cosmeticsdesign-europe.com/Article/2021/04/15/Colgate-patents-cannabinoid-CBD-oral-care-toothpaste-and-mouthwash-for-antibacterial-anti-inflammatory-properties

'There was no significant evidence in the studied population relating periodontal disease with cannabis consumption. The response of periodontal tissues to non-surgical therapy was similar between cannabis users and non-users.'

https://www.scielo.sa.cr/scielo.php?pid=S2215-34702021000100312&script=sci_arttext&tlng=en

'Objective: Two patient case reports are presented describing the use of cannabidiol (CBD) for the symptomatic relief of a lumbar compression fracture and in the mitigation of thoracic discomfort and dysesthesia secondary to a surgically resected meningioma.

Discussion: CBD appears to have antisnociceptive and anti-inflammatory effects on opioid-naive patients with neuropathic and radicular pain. Of note, the patients in this case series used the same CBD cream: Baskin Essentials Body Wellness Cream (400 mg CBD per two oz.)

Conclusion: Hemp-derived CBD in a transdermal cream provided significant symptom and pain relief for the patients described in this case series. Based on these results, we believe further investigation is warranted to see if CBD-containing products should have a more prominent role in the treatment of acute and chronic pain.'

https://wmpllc.org/ojs/index.php/jom/article/view/2748

 

 

'Recent Findings
The endocannabinoid system consists of endogenous ligands, receptors, and enzymes. The main cannabinoids found in the cannabis plant are delta9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

Cannabinoid receptors CB1 and CB2 are expressed in bone and regulate bone homeostasis in rodents and humans. CBD treatment was shown to enhance fracture healing in rats. Recent studies in mice indicate that strain, age, and sex differences dictate the skeletal outcome of the EC activation.

Summary
CBD treatment was shown to enhance bone healing, but needs validation in clinical trials. While research shows that EC activity protects against bone loss, studies on CB1 and CB2 agonists in bone regeneration models are lacking. Whether modulating the EC system would affect bone repair remains therefore an open question worth investigating.'

https://link.springer.com/article/10.1007/s11914-020-00607-1

'As yet insufficient time has elapsed to reveal the full effect of the new chlorinated hydrocarbon insecticides and of the modern herbicides. Most malignancies develop so slowly that they may require a considerable segment of the victim's life to reach the stage of showing clinical symptoms. In the early 1920s women who painted luminous figures on watch dials swallowed minute amounts of radium by touching the brushes to their lips; in some of these women bone cancers developed after a lapse of 15 or more years. A period of 15 to 30 years or even more has been demonstrated for some cancers caused by occupational exposures to chemical carcinogens.

In contrast to these industrial exposures to various carcinogens the first exposures to DDT date from about 1942 for military personnel and from about 1945 for civilians, and it was not until the early fifties that a wide variety of pesticidal chemicals came into use. The full maturing of whatever seeds of malignancy have been sown by these chemicals is yet to come.' - Silent Spring, Rachel Carson, 1962


'Results
Both CB1 and CB2 were expressed in periodontal tissues but with different expression patterns. THC promoted periodontal cell wound healing by inducing HPLF cell adhesion and migration. This was mediated by focal adhesion kinase (FAK) activation and its modulation of MAPK activities. The effect of cannabinoids on periodontal fibroblast cell adhesion and migration were mainly dependent on the CB2.

Conclusion
These results suggested that cannabinoids may contribute to developing new therapeutics for periodontal regeneration and wound healing.'
https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpe.13190


'Orthopedic surgeons specialize in the treatment of conditions involving the musculoskeletal system. They are the third highest prescribers of opioids among physicians in the United States.

Investigators reported that that the "implementation of medical THC-grade cannabis laws and patient accessibility to in-state dispensaries are each associated with significantly reduced opioid prescribing by orthopedic surgeons."'
https://norml.org/news/2020/05/28/study-orthopedic-surgeons-issue-fewer-opioid-prescriptions-following-medical-cannabis-legalization


'Hemp-derived cannabidiol (CBD) is the major non-psychoactive component of cannabis and has been promoted as a potential treatment for a wide variety of disparate inflammatory conditions. Here we evaluated CBD for its ability to modulate the production of pro-inflammatory cytokines in vitro and in murine models of induced inflammation and further validated the ability of a liposomal formulation to increase bioavailability in mice and in humans. Subsequently, the therapeutic potential of both naked and liposomally-encapsulated CBD was explored in a 4-week, randomized placebo-controlled, double-blinded study in a spontaneous canine model of osteoarthritis. In vitro and in mouse models, CBD significantly attenuated the production of pro-inflammatory cytokines IL-6 and TNF-a while elevating levels of anti-inflammatory IL-10. In the veterinary study, CBD significantly decreased pain and increased mobility in a dose-dependent fashion among animals with an affirmative diagnosis of osteoarthritis. Liposomal CBD (20 mg/day) was as effective as the highest dose of non-liposomal CBD (50 mg/day) in improving clinical outcomes. Hematocrit, comprehensive metabolic profile, and clinical chemistry indicated no significant detrimental impact of CBD administration over the four week analysis period.'
https://www.jimmunol.org/content/204/1_Supplement/67.11.abstract


'Ninety percent of those currently using cannabis for pain management said that it provided either moderate or significant relief and 40 percent of subjects reported having decreased their consumption of other analgesic medications following their initiation of cannabis therapy. Pain patients most frequently reported consuming products high in CBD rather than THC.'
https://norml.org/news/2020/07/09/survey-one-in-five-patients-report-using-cannabis-products-for-musculoskeletal-pain


'Results of the experiment indicated that the two cannabinoid-infused mouthwashes significantly inhibited the growth of bacteria—on par with the chlorhexidine. The two over-the-counter mouthwashes, meanwhile, had little to no detectable effect.

“Cannabinoids (CBD / CBG) infused mouthwashes together with other natural key ingredients shows promising bactericidal activity in vitro against total-culturable aerobic bacterial content in dental plaque,” the study says, “with efficiency equivalent to or better than that of the gold standard (0.2% chlorhexidine).”'
https://www.marijuanamoment.net/cbd-infused-mouthwash-works-better-than-regular-products-industry-study-shows/

'"We found that CBD alone makes bones stronger during healing, enhancing the maturation of the collagenous matrix, which provides the basis for new mineralization of bone tissue," said Dr. Gabet. "After being treated with CBD, the healed bone will be harder to break in the future."'
https://www.sciencedaily.com/releases/2015/07/150716124359.htm


'As adverse reactions of cannabinoids haven’t been described in patients under controlled medication, cannabinoids can represent future treatment for bone regeneration.'
https://www.tandfonline.com/doi/abs/10.1080/03602532.2019.1574303?journalCode=idmr20&


'Thus, osteoporosis joins a growing list of human disorders, including obesity and nicotine dependence, that may be treatable by drugs targeting the cannabinoid receptors, a class of proteins originally discovered as the binding sites for the major psychoactive ingredient of marijuana'
http://science.sciencemag.org/content/308/5727/1379.2


'Jason is a former skateboard prodigy who now has spinal injuries and prefers medical marijuana over prescription opiates and narcotics.'
https://video.nationalgeographic.com/tv/american-weed/marijuana-medicine


'In summary our study revealed anti-degenerative effects of intradiscal microinjection of CBD 120 nmol. CBD represents one of the most promising candidates present in the Cannabis sativa plant for clinical use due to its remarkable lack of cognitive or psychotomimetic actions. It has been already approved in several countries for the treatment of neuropathic pain. Although further research is necessary to clarify the mechanisms involved in CBD effects, the present results suggest the possibility of its use for disc degeneration treatment.'
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113161


'The results indicate that cannabinoid agonists (THC/CBD) can have remarkable analgesic capabilities, as adjuvant of SCS (spinal cord stimulation), for the treatment of chronic refractory pain of FBSS (failed back surgery syndrome) patients.'
https://www.dovepress.com/cannabinoids-and-spinal-cord-stimulation-for-the-treatment-of-failed-b-peer-reviewed-article-JPR