Abstract
Aim. The incidence of diabetic osteoporosis (DOP) is increasing due to lack of effective management over the past few decades. This review aims to summarize traditional Chinese medicine (TCM) suitability in the pathogenesis and clinical and preclinical management of DOP. Methods. Literature sources used were from Medline (Pubmed), CNKI (China Knowledge Resource Integrated Database), and CSTJ (China Science and Technology Journal Database) online databases. For the consultation, keywords such as diabetic osteoporosis (DOP), TCM, clinical study, animal experiment, toxicity, and research progress were used in various combinations. Around 100 research papers and reviews were visited. Results. Liver-spleen-kidney insufficiency may result in development of DOP. 18 clinical trials are identified to use TCM compound prescriptions for management of patients with DOP. TCM herbs and their active ingredients are effective in preventing the development of DOP in streptozotocin (STZ) and alloxan as well as STZ combined with ovariectomy insulted rats. Among them, most frequently used TCM herbs in clinical trials are Radix Astragali, Radix et Rhizoma Salviae Miltiorrhizae, Radix Rehmanniae Preparata, and Herba Epimedii. Some of TCM herbs also exhibit toxicities in clinical and preclinical research. Conclusions. TCM herbs may act as the novel sources of anti-DOP drugs by improving bone and glucolipid metabolisms. However, the pathogenesis of DOP and the material base of TCM herbs still merit further study.
Highlights
Diabetic osteoporosis (DOP) is a chronic bone metabolic disease induced by diabetes mellitus (DM), and its pathogenesis involves an increase in osteoclast activity, a decrease in osteoblast activity, aggravation of bone microcirculation, an increase in adipogenic differentiation of mesenchymal multipotential stem cells (MMSCs), and an increase in advanced glycation end products (AGEs) [1, 2]
Effective: symptoms and physical signs score decreased between 30% and 70%; bone mineral density (BMD) increased between 1% and 2%; bone metabolism index improved; FPG and 2 hPG decreased by ⩾20%; HbA1C decreased between 10% and 30%
The clinical studies and basic research achievements support that traditional Chinese medicine (TCM) offers a new strategy in prevention and treatment of diabetic osteoporosis (DOP) (Scheme 1)
Summary
Diabetic osteoporosis (DOP) is a chronic bone metabolic disease induced by diabetes mellitus (DM), and its pathogenesis involves an increase in osteoclast activity, a decrease in osteoblast activity, aggravation of bone microcirculation, an increase in adipogenic differentiation of mesenchymal multipotential stem cells (MMSCs), and an increase in advanced glycation end products (AGEs) [1, 2]. With the increasing incidence of DM in the world, the number of patients with DOP increased [3]. Clinical studies have shown that about 1/2 to 2/3 of diabetic patients suffered from decreasing bone strength and/or increasing incidence of fractures, of whom nearly 1/3 were diagnosed as osteoporosis [4]. Traditional Chinese medicine (TCM) has attracted increasing attention in prevention and treatment of DOP. This review highlights the pathogenetical, clinical, and experimental advances in management of DOP in TCM and provides a strong scientific evidence for understanding and improving the treatment of DOP
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