Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi, 62247, Taiwan.
Rehabilitation Counseling Program, Portland State University, Portland, OR, 97207-0751, USA.
Osteoporos Int. 2019 Apr;30(4):807-815. doi: 10.1007/s00198-018-4789-x. Epub 2019 Feb 5.
UNLABELLED: After utilizing a large population-based claims database and the application of propensity score match approach to reduce the confounding effects, we found that the use of Chinese herbal medicines (CHMs) was related to the lower risk of sequent osteoporotic fracture by 27% among the individuals with osteoporosis. The predominant effect was observed in those receiving CHMs for more than two years. INTRODUCTION: Osteoporosis (OS) is a highly disabling condition that can lead to fragility fracture, thus posing greater burdens of functional limitations for the affected individuals. It is unclear if the use of Chinese herbal medicines (CHMs) could reduce the risk of fracture due to OS. This study aimed to investigate the association of CHMs and the subsequent osteoporotic fracture risk among OS patients. METHODS: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 250,699 newly diagnosed OS patients aged 20 years or older between 1998 and 2010. We recruited 103,325 CHM users following the onset of OS (CHM users) and randomly selected 103,325 subjects without CHM usage as controls (non-CHM users) by propensity score matching according to the demographic characteristics and comorbidities at enrollment. All enrollees were followed until the end of 2012 to record the incidence of osteoporotic fracture. We applied the Cox proportional hazard regression model to compute the hazard ratio (HR) of the risk of osteoporotic fracture. RESULTS: During the 15-year follow-up period, 7208 CHM users and 11,453 non-CHM users sustained osteoporotic fracture, with an incidence rate of 9.26 and 12.96, respectively, per 1000 person-years. We found that CHM users had a significantly reduced risk of osteoporotic fracture compared to non-CHM users (adjusted HR 0.73; 95% confidence interval [CI] = 0.70-0.75). Those treated with CHMs for longer than 730 days had a lower fracture risk by 54%. Some commonly used CHMs, such as Yan hu suo (Rhizoma Corydalis), Huang Qin (Scutellaria Baicale), Jie Geng (Platycodon grandifloras), Xiang Fu (Cyperus rotundus), Hai Piao Xiao (Cuttlebone Sepium), Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, and Du-Huo-Ji-Sheng-Tang, are related to the lower risk of fracture. CONCLUSIONS: The use of CHMs was associated with lower risk of osteoporotic fracture for OS patients, suggesting that it could be integrated into conventional therapy to prevent subsequent bone fracture.
目的：骨质疏松症（OS）是一种高度致残的疾病，可导致脆性骨折，从而给受影响的个体带来更大的功能受限负担。目前尚不清楚使用中草药（CHMs）是否可以降低因 OS 导致的骨折风险。本研究旨在探讨 CHMs 与 OS 患者随后发生骨质疏松性骨折风险之间的关联。
方法：本纵向队列研究使用台湾全民健康保险研究数据库，确定了 1998 年至 2010 年间 250699 名年龄在 20 岁或以上的新诊断为 OS 的患者。我们在 OS 发病后招募了 103325 名 CHM 用户（CHM 用户），并根据入组时的人口统计学特征和合并症，通过倾向评分匹配随机选择了 103325 名未使用 CHM 的受试者作为对照（非 CHM 用户）。所有入组者均随访至 2012 年底，以记录骨质疏松性骨折的发生率。我们应用 Cox 比例风险回归模型计算骨质疏松性骨折风险的风险比（HR）。
结果：在 15 年的随访期间，7208 名 CHM 用户和 11453 名非 CHM 用户发生了骨质疏松性骨折，其发生率分别为每 1000 人年 9.26 和 12.96。我们发现，与非 CHM 用户相比，CHM 用户发生骨质疏松性骨折的风险显著降低（调整后的 HR 0.73；95%置信区间[CI] = 0.70-0.75）。那些接受 CHMs 治疗超过 730 天的患者骨折风险降低了 54%。一些常用的 CHMs，如延胡索（Rhizoma Corydalis）、黄芩（Scutellaria Baicale）、桔梗（Platycodon grandifloras）、香附（Cyperus rotundus）、海螵蛸（Cuttlebone Sepium）、加味逍遥散、葛根汤、芍药甘草汤、独活寄生汤，与较低的骨折风险相关。
结论：OS 患者使用 CHMs 与较低的骨质疏松性骨折风险相关，这表明 CHMs 可以整合到常规治疗中，以预防随后的骨折。
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