Abstract
ObjectiveThe clinical efficacy of Xianling Gubao capsule (XLGB) and its combination therapy in the treatment of postmenopausal osteoporosis (PMOP) was systematically evaluated by frequency-based network meta-analysis.MethodsWe searched the China National Knowledge Infrastructure (CNKI), Wanfang, SinoMed, PubMed, Embase and Cochrane Library databases to identify clinical trials of XLGB for the treatment of PMOP from the establishment of each database to November 22, 2021. The quality of the included studies was evaluated by using the risk of bias assessment tool version 2.0 (Rob 2.0) recommended by Cochrane. Stata 14.0 was applied for statistical analysis of the data, and the surface under the cumulative ranking curve (SUCRA) was used to rank the intervention measures of each outcome index.ResultsThis study included 22 clinical trials (including 19 RCTs and 3 non-RCTs) involving 12 drug therapies. According to the results of the network meta-analysis and SUCRA, the best three interventions for improving lumbar bone mineral density (BMD) are XLGB+BP+calcium (83.7%), XLGB+BP (68.5.7%) and XLGB+VD (67.1%). XLGB+calcium was the best combination regimen for improving femoral neck BMD and increasing bone Gla protein (BGP) and alkaline phosphatase (ALP) contents in serum. The SUCRA values of XLGB+calcium for improving the three outcome indicators were 68.0%, 59.5% and 82.1%, respectively.ConclusionsThe results of this network meta-analysis show that combined application of XLGB can effectively improve BMD and serum BGP and ALP compared to calcium alone, VD or BP. In the future, multicenter, large-sample and double-blind clinical RCTs should be carried out to supplement and verify the results of this study.
Highlights
Postmenopausal osteoporosis (PMOP) is a systemic metabolic bone disease characterized by decreased bone mass, increased bone fragility and easy fracture [1]
2) Interventions and comparisons: the experimental group was treated with XLGB alone or combined with XLGB on the basis of routine intervention measures in the control group; the control group was treated with no intervention, placebo or conventional Western medicine
The results of the network meta-analysis showed obvious advantages for XLGB+calcium in improving lumbar BMD compared with calcium alone (MD = 0.13, 95% confidence interval (CI) [0.05, 0.20]), and the difference was statistically significant
Summary
Postmenopausal osteoporosis (PMOP) is a systemic metabolic bone disease characterized by decreased bone mass, increased bone fragility and easy fracture [1]. There are approximately 27.6 million patients with osteoporosis over 50 years old in EU countries, including 22 million women, with a prevalence rate of 22.1% [3]. The prevalence rate of osteoporosis in women is approximately three times that in men [3]. The decline in ovarian function and the decrease in estrogen secretion in postmenopausal women can lead to an imbalance in bone turnover, a decrease in bone mass and an increase in bone fragility [4]. Bisphosphonates, estrogens and other drugs recommended in clinical practice guidelines have good clinical efficacy, but their safety remains a concern [4, 6]. It is important to seek effective drugs while improving drug safety
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