Yoo Young-Seo, Kim Min-Gyeong, Park Hee-Joo, Chae Min-Young, Choi Yu-Jin, Oh Chae-Kun, Son Chang-Gue, Lee Eun-Jung
College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.
Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.
Front Pharmacol. 2024 Sep 13;15:1413515. doi: 10.3389/fphar.2024.1413515. eCollection 2024.
Osteoporosis (OP) is a significant medical issue associated with population aging. Recent research on herbal medicines (HMs) for OP has been increasing, with these therapies sometimes used in conjunction with bisphosphonates (BPs), the standard treatment for OP. We conducted a systematic review and meta-analysis to evaluate the effects of combining HMs with BPs on improving bone mineral density (BMD) in patients with primary OP.
We searched nine databases-PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Wanfang, KISS, Kmbase, Science On, and Oasis-up to 31 August 2023. We selected randomized controlled trials (RCTs) comparing BMD between HMs BPs and BPs alone in primary OP. A meta-analysis with BMD as the primary outcome was performed using RevMan version 5.4. Study quality and evidence certainty were assessed through Cochrane's risk of bias2 and GRADE.
Out of 43 RCTs involving 4,470 participants (mean age 65.8 ± 6.6 years), 35 RCTs with 3,693 participants were included in the meta-analysis. The combination of HMs and BPs was found to be more effective in improving BMD compared to BPs alone, with improvements of 0.10 g/cm at the lumbar spine (33 RCTs, 95% CI: 0.07-0.12, < 0.001, I = 93%) and 0.08 g/cm at the femoral neck (20 RCTs, 95% CI: 0.05-0.12, < 0.001, I = 94%), though this result was associated with high heterogeneity, high risk of bias, and very low certainty of evidence.
Our data suggest the possibility that combining HMs with BPs may improve BMD in primary OP more effectively than using BPs alone. However, the results should be interpreted with caution due to the high heterogeneity and low quality of the studies included in the review. Therefore, further well-designed RCTs are needed to confirm these findings.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023392139.
骨质疏松症（OP）是一个与人口老龄化相关的重大医学问题。近年来，关于用于治疗OP的草药（HMs）的研究不断增加，这些疗法有时会与OP的标准治疗药物双膦酸盐（BPs）联合使用。我们进行了一项系统评价和荟萃分析，以评估HMs与BPs联合使用对改善原发性OP患者骨密度（BMD）的效果。
我们检索了9个数据库——截至2023年8月31日的PubMed、Embase、Cochrane图书馆、中国知网、万方、KISS、Kmbase、Science On和Oasis。我们选择了比较HMs联合BPs与单独使用BPs治疗原发性OP患者BMD的随机对照试验（RCTs）。使用RevMan 5.4版以BMD作为主要结局进行荟萃分析。通过Cochrane偏倚风险2和GRADE评估研究质量和证据确定性。
在涉及4470名参与者（平均年龄65.8±6.6岁）的43项RCTs中，35项涉及3693名参与者的RCTs被纳入荟萃分析。结果发现，与单独使用BPs相比，HMs与BPs联合使用在改善BMD方面更有效，腰椎处BMD提高了0.10g/cm（33项RCTs，95%CI：0.07 - 0.12，P<0.001，I² = 93%），股骨颈处提高了0.08g/cm（20项RCTs，95%CI：0.05 - 0.12，P<0.001，I² = 94%），不过这一结果存在高度异质性、高偏倚风险和极低的证据确定性。
我们的数据表明，HMs与BPs联合使用可能比单独使用BPs更有效地改善原发性OP患者的BMD。然而，由于纳入综述的研究存在高度异质性和低质量，这些结果应谨慎解读。因此，需要进一步设计良好的RCTs来证实这些发现。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023392139 。
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