Abstract
Purpose To evaluate the effectiveness and safety of acupoint catgut embedding therapy (ACET) in postmenopausal osteoporosis (PMOP). Methods Review of some databases from their inception to June 2018 and randomized controlled trials (RCTs) in which ACET with PMOP were included. Two researchers extracted and evaluated the information independently. Cochrane Collaboration's tool and Jadad scale were used to evaluate the quality of the studies. RevMan V.5.3.3 software was used to carry out the meta-analysis while trial sequential analysis (TSA) performed with TSA 0.9 software. Results 12 RCTs with 876 participants were included in this review. Meta-analysis showed that ACET alone was not superior to medication in effectiveness rate (RR= 1.11; 95% CI (0.89, 1.40); P=0.35) and E2 (SMD= 0.20; 95% CI (-0.17, 0.57); P=0.28; I2=20%) while ACET combining medication was more effective on the effectiveness rate (RR= 1.32; 95% CI (1.20, 1.46); P<0.000 01) and E2 (SMD= 1.24; 95% CI (0.63, 1.84); P<0.0001). Additionally, ACET combining calcium could increase the bone mineral density (BMD) of the L2~4 vertebrae and femur-neck [WMDL2~4 = 0.03; 95% CI (0.01, 0.05); P=0.003; and WMDFemur-neck = 0.07; 95% CI (0.03, 0.10); P = 0.0006], reduce TCM syndrome score [WMD = -1.85; 95% CI (-2.13, -1.57); P<0.000 01], improve patient's quality of life [WMDthree months = 6.90; 95% CI (3.90, 9.89); P<0.000 01; and WMDsix months = 12.34; 95% CI (5.09, 19.60); P=0.0009], and relieve pain [WMDVAS = -1.26; 95% CI (-1.66, -0.85); P<0.000 01; and WMDPain score = -2.59; 95% CI (-4.76, -0.43); P= 0.02]. The TSA showed that the effectiveness of ACET for PMOP was demonstrated accurately. Conclusions ACET combining medication but not ACET alone is more effective than medication as comparison in the treatment of PMOP. As a novel treatment, ACET shows the potential of effectiveness and deserves further high quality of well-designed study.
Highlights
Postmenopausal osteoporosis (PMOP) is a common clinical disease characterized by bone mass reduction and microarchitecture degradation [1, 2] that contributes to an increased risk of bone fragility and fracture
In the remaining trials [28,29,30,31,32,33,34], acupoint catgut embedding therapy (ACET) combining calcium supplements served as the experimental group, and calcium supplements alone served as the control group
The random-effect model was employed and the results showed a significant difference between the experimental and control groups (WMD= 0.03; 95% confidence intervals (CIs) (0.01, 0.05); P=0.003), suggesting that ACET combining calcium supplements was more effective than calcium supplements alone for enhancing the bone mineral density (BMD) of L2, L3, and L4 (Figure 3(b))
Summary
Postmenopausal osteoporosis (PMOP) is a common clinical disease characterized by bone mass reduction and microarchitecture degradation [1, 2] that contributes to an increased risk of bone fragility and fracture. A high incidence of pain, and high disability rates are hallmarks of the disease These symptoms seriously affect the quality of life of many postmenopausal women [8]. The long-term use of these drugs represents an economic burden for affected patients These medications have serious side effects in the gastrointestinal tract, even leading to endometrialgia, breast cancer, oesophageal cancer, kidney stones, and other issues [10]. ACET has marked advantages in terms of overcoming the high cost of health care, reducing the toxicity and side effects of drugs, shortening the frequency and duration of traditional acupuncture treatments, and improving patient compliance [12, 18]. This study systematically evaluated the effectiveness and safety of existing RCTs of ACET in the treatment of PMOP, to optimize acupoint interventions for the treatment of osteoporosis and provide a basis for clinical treatment
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