Treatment Of Primary Osteoporosis Research Articles

Efficacy of Xianling Gubao capsule vs. its combination therapy in the treatment of primary osteoporosis: A network meta-analysis of randomized controlled trials

ObjectiveThis study aimed to evaluate the efficacy of the Xianling Gubao (XLGB) capsule alone and its combination therapy in primary osteoporosis (POP). MethodsDatabases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and SinoMed were searched from their inception to January 16, 2024, for randomized controlled trials (RCTs) investigating the XLGB treatment for POP. A network meta-analysis (NMA) was performed to evaluate the efficacy and safety of multiple interventions in the treatment of POP. The Cochrane risk-of-bias tool was used to assess the quality of RCTs included in the meta-analysis. Software Stata (version 15.0) was used for statistical analysis. The surface under the cumulative ranking curve (SUCRA) method was used to present the findings from this NMA numerically and graphically by ranking multiple interventions. ResultsA total of 107 RCTs were included in the meta-analysis, involving 10,032 participants and 21 interventions. Meta-analysis showed that XLGB + calcium (Ca) + calcitonin (99.9 %) was the most desirable treatment option for improving clinical efficacy. XLGB + Ca + bisphosphonate (BP) was most effective for improving bone mineral density (BMD) at the lumbar spine, femoral neck BMD, and serum bone Gla protein (BGP). SUCRA values for improving these three outcome measures by XLGB + Ca + BP were 87.4 %, 77.2 %, and 84.3 %, respectively. XLGB + calcitonin was the optimal option in terms of safety evaluation and improving visual analogue scale (VAS), with the SUCRA values being 89.6 % and 94.9 %, respectively. ConclusionsThe XLGB combination therapy is a desirable option for treating POP as it can effectively improve the therapeutic effects, BMD, and serum BGP, as well as relieve pain in patients with POP.

Effects of kidney tonic herbs for primary osteoporosis: A systematic review and meta-analysis.

Primary osteoporosis (POP) is one of the most common orthopedic conditions with a high risk of fractures. Effective treatment of POP is crucial for reducing disability rates and improving quality of life. Kidney tonic therapy is a classical traditional Chinese medicine approach for treating POP. This study aims to provide a comprehensive and reliable assessment of the clinical evidence of kidney tonic herbs (KTH) in treating POP patients. An extensive literature search was conducted in 8 electronic databases from their inception through September 30, 2022, to evaluate the efficacy and safety of KTH for POP. We included 43 randomized controlled trials with 4349 participants. The qualified studies will be chosen and evaluated separately by 2 researchers. The primary outcome measure was bone mineral density (BMD) of lumbar. RevMan 5.3 and Stata 16 were used to carry out the meta-analyses. Our meta-analysis showed 29 studies with significantly increased lumbar BMD (mean difference [MD] = 0.06; 95% confidence interval [CI]; I2 = 98%, P = .003), 18 studies with noticeably higher femoral neck BMD (MD = 0.08; 95% CI; I2 = 98%, P = .0005), 6 studies with significantly increased femoral trochanter BMD (MD = 0.10; 95% CI; I2 = 97%, P = .002), 4 studies with noticeably higher ward's triangle BMD (MD = 0.13; 95% CI; I2 = 100%, P = .04), and 3 studies with noticeably higher distal radius BMD (MD = 0.06; 95% CI; I2 = 86%, P = .009). One study showed 12 falls and 8 fallers in the intervention group, 28 falls and 17 fallers in the control group at 36 months. 3 studies showed a significant difference in fracture incidence between the intervention group and the control group (95% CI: 0.15-0.81; I2 = 0%, P = .01). Additionally, the meta-analysis demonstrated that KTH offered superior pain relief (8 trials, n = 980; 95% CI: -1.05 to -0.74; I2 = 94%, P < .00001). Besides, KTH found no serious harmful effects. KTH may increase BMD and decrease the likelihood of fractures in POP patients. However, further research is necessary to investigate the effectiveness of KTH in reducing falls and fractures.

Regular sling core stabilization training improves bone density based on calcium and vitamin D supplementation

BackgroundPrimary osteoporosis refers to a disease of aging characterized by reduced bone mass, damage to bone tissue microarchitecture, and predisposition to fracture.Sling core stabilization training emphasizes activating the deep local muscles of the spine under unstable conditions, and enhancing the body’s balance and control during exercise.Case presentationA 70-year-old female went to the Acupuncture and Rehabilitation Department due to low back pain caused by osteoporosis.The patient received sling core stabilization training three times a week based on Calcium and Vitamin D Supplementation. After training, the patient’s back pain was significantly relieved and insisted one year. In the physical examination of bone mineral density, the results showed that the value of bone mineral density was better than last year.The patients adhered to sling core stabilization training and observed the changes of bone mineral density every year basis on calcium and vitamin D supplementation.DiscussionHowever, cases of calcium and vitamin D supplementation-based regular sling core stabilization training that improves bone density in osteoporosis patients have been rarely reported. Our group shared cases and analyzed possible mechanisms, hoping to provide reference for the prevention and treatment of primary osteoporosis.

Systematic review and Meta-analysis of Gusongbao preparation in treatment of primary osteoporosis

This study aims to provide evidence for clinical practice by systematically reviewing the efficacy and safety of Gusongbao preparation in the treatment of primary osteoporosis(POP). The relevant papers were retrieved from four Chinese academic journal databases and four English academic journal databases(from inception to May 31, 2022). The randomized controlled trial(RCT) of Gusongbao preparation in the treatment of POP was included after screening according to the inclusion and exclusion criteria. The quality of articles was evaluated using risk assessment tools, and the extracted data were subjected to Meta-analysis in RevMan 5.3. A total of 657 articles were retrieved, in which 15 articles were included in this study, which involved 16 RCTs. A total of 3 292 patients(1 071 in the observation group and 2 221 in the control group) were included in this study. In the treatment of POP, Gusongbao preparation+conventional treatment was superior to conventional treatment alone in terms of increasing lumbar spine(L2-L4) bone mineral density(MD=0.03, 95%CI[0.02, 0.04], P&lt;0.000 01) and femoral neck bone mineral density, reducing low back pain(MD=-1.69, 95%CI[-2.46,-0.92], P&lt;0.000 1) and improving clinical efficacy(RR=1.36, 95%CI[1.21, 1.53], P&lt;0.000 01). Gusongbao preparation was comparable to similar Chinese patent medicines in terms of improving clinical efficacy(RR=0.95, 95%CI[0.86, 1.04], P=0.23). Gusongbao preparation was inferior to similar Chinese patent medicines in reducing traditional Chinese medicine syndrome scores(MD=1.08, 95%CI[0.44, 1.71], P=0.000 9) and improving Chinese medicine syndrome efficacy(RR=0.89, 95%CI[0.83, 0.95], P=0.000 4). The incidence of adverse reactions of Gusongbao preparation alone or combined with conventio-nal treatment was comparable to that of similar Chinese patent medicines(RR=0.98, 95%CI[0.57, 1.69], P=0.94) or conventio-nal treatment(RR=0.73, 95%CI[0.38, 1.42], P=0.35), and the adverse reactions were mainly gastrointestinal discomforts. According to the available data, Gusongbao preparation combined with conventional treatment is more effective than conventional treatment alone in increasing lumbar spine(L2-L4) bone mineral density and femoral neck bone mineral density, reducing low back pain, and improving clinical efficacy. The adverse reactions of Gusongbao preparation were mainly gastrointestinal discomforts, which were mild.

Network Meta-analysis of Oral Chinese Patent Medicine in Treatment of Primary Osteoporosis

The efficacy of oral proprietary Chinese medicine in the prevention and treatment of primary osteoporosis was systematically evaluated through a network meta-analysis. The computer retrieved the four major Chinese databases of CNKI, VIP, Wang Fang, CBM in China and abroad, as well as the three English databases and Web of Science of Medline, EMbase and Cochrane Library. The search cycle was designed as the database was established until February 15, 2022, and screened randomized controlled trials of export taking proprietary Chinese medicine combined with conventional western medicine for the prevention and treatment of primary osteoporosis according to the system evaluation pre-formulated exclusion criteria. Literature screening and data extraction are completed by at least 2 clinical investigators alone. Bias assessment and mapping of included studies using the Revman software, using the Cochrane Bias Risk Assessment tool, using Stata 16. 0 Software for data acquisition and analysis. In the end, 19 RCTS were included, involving 8 kinds of oral proprietary Chinese medicines (You Gui Pills, Jin Tiange Capsules, Gu Shu Kang Granules, Qiang Bone Capsules, Gu Songbao Granules, Xianling Gu Bao Capsules, Hu Gu Capsules, Zuo Gui Pills). The results of the network meta-study are as follows: (1) in terms of improving clinical efficiency, conventional western medicine combined with Hu Gu Capsules has the best effect; (2) in terms of improving bone density, conventional western medicine combined with Xianling Gu Bao has the best effect. This network meta-analysis provides evidence for the efficacy of the above eight proprietary Chinese medicines in the treatment of patients with POP.

Identification and validation of ferroptosis key genes in bone mesenchymal stromal cells of primary osteoporosis based on bioinformatics analysis.

Primary osteoporosis has long been underdiagnosed and undertreated. Currently, ferroptosis may be a promising research direction in the prevention and treatment of primary osteoporosis. However, the specific mechanism of ferroptosis in primary osteoporosis remains a mystery. Differentially expressed genes (DEGs) were identified in bone mesenchymal stromal cells (BMSCs) of primary osteoporosis and heathy patients from the GEO databases with the help of bioinformatics analysis. Then, we intersected these DEGs with the ferroptosis dataset and obtained 80 Ferr-DEGs. Several bioinformatics algorithms (PCA, RLE, Limma, BC, MCC, etc.) were adopted to integrate the results. Additionally, we explored the potential functional roles of the Ferr-DEGs via GO and KEGG. Protein–protein interactions (PPI) were used to predict potential interactive networks. Finally, 80 Ferr-DEGs and 5 key Ferr-DEGs were calculated. The 5 key Ferr-DEGs were further verified in the OVX mouse model. In conclusion, through a variety of bioinformatics methods, our research successfully identified 5 key Ferr-DEGs associated with primary osteoporosis and ferroptosis, namely, sirtuin 1(SIRT1), heat shock protein family A (Hsp70) member 5 (HSPA5), mechanistic target of rapamycin kinase (MTOR), hypoxia inducible factor 1 subunit alpha (HIF1A) and beclin 1 (BECN1), which were verified in an animal model.

Chinese Proprietary Medicine Xianling Gubao Capsule for Osteoporosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

ObjectiveTo assess the benefit and harm of Chinese medicine Xianling Gubao (XLGB) capsule compared to conventional medication or placebo to inform clinical practice.MethodsWe included randomized controlled trials (RCTs) with Jadad score ≥3 of XLGB capsule compared to pharmaceutical medication, placebo, or no treatment for primary osteoporosis. We conducted searches in EMBASE, Cochrane CENTRAL, MEDLINE, China National Knowledge Infrastructure, VIP, Wanfang, and Chinese Biomedical Literature Database (Sino-Med) from their inception till November 13th, 2021. Study selection and data extraction were done by two authors independently. The methodological quality of the RCTs was assessed using Cochrane’s risk of bias tool. The effect size was presented as risk ratio (RR) or mean difference (MD) with their 95% confidence interval (CI).ResultsOur searches identified 2292 records and after exclusions, eight trials involving 846 participants were included. There was no statistically significant difference between conventional medications with or without XLGB on new fracture (RR: 0.50, 95% CI: [0.13, 1.87]). Quality of life by SF-36 questionnaire of XLGB plus calcium carbonate, vitamin D3, and calcitriol was improved than that of without XLGB (MD: 6.72 scores, 95% CI: [2.82, 10.62]). XLGB increased bone mineral density similarly as calcium carbonate plus vitamin D3 (MD: 0.21, 95% CI: [-0.16, 0.58]) or as alendronate sodium, calcium carbonate plus vitamin D3 (MD: 0.00, 95% CI: [-0.10, 0.10]), but it had no additional effect as an add-on treatment to conventional medications (MD: 0.13, 95% CI: [-0.12, 0.37]). XLGB relieved pain via visual analog scale more effectively when combined with medications (MD: -1.55 score, 95% CI: [-2.47, -0.63]). XLGB as monotherapy did not increase adverse events (RR: 0.63, 95% CI: [0.28, 1.41]), or as an add-on treatment (RR: 0.25, 95% CI: [0.03, 2.16]).ConclusionThis systematic review shows that XLGB capsule appears to be safe and has a beneficial effect on the quality of life and pain relief when used alone or in combination with conventional medications in osteoporosis patients. Further large, rigorous trials are warranted to test its long-term benefit.

Factors affecting spine\u2013femur discordance in the percentage of young adult mean on dual-energy X-ray absorptiometry in the elderly population: a retrospective study

BackgroundSeveral retrospective studies have reported spine–femur discordance in bone mineral density (BMD) values. However, the average age of individuals in these studies was the mid-50s, which is younger than the typical age of individuals requiring treatment for primary osteoporosis. Therefore, we aimed to investigate factors associated with discordance in the percentage of young adult mean (YAM) between the lumbar spine and femoral neck in the elderly population.MethodsWe evaluated 4549 dual-energy X-ray absorptiometry (DXA) measurements obtained from 2161 patients (269 men and 1892 women) between January 2014 and December 2017 at our hospital. For individuals with more than one eligible set of measurements, the first record was used. We investigated each patient’s age, sex, body mass index, current smoking status, alcohol consumption, use of steroids, presence of diabetes mellitus, and presence of rheumatoid arthritis.ResultsThe mean age of the patients was 76.4 ± 8.9 years. Older age (p < 0.001), male sex (p < 0.001), and diabetes mellitus (p = 0.007) were significantly associated with spine–femur discordance in the percentage of YAM.ConclusionThe frequency and magnitude of spine–femur discordance in the percentage of YAM from DXA scans increased with age. Notably, more than 77.4% of patients in their 90s had spine–femur discordance > 10% of YAM. Furthermore, the frequency of spine–femur discordance was higher in men and in patients with diabetes mellitus, suggesting that the percentage of YAM at the lumbar spine may not be reliable for diagnosis of osteoporosis in patients with these factors.

The Efficacy and Safety of Chinese Herbal Medicine Xianling Gubao Capsule Combined With Alendronate in the Treatment of Primary Osteoporosis: A Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.

Objective: Herein, we purposed to evaluate the efficacy along with the safety of Xianling Gubao capsule (XLGB) combined with alendronate (ALE) for primary osteoporosis (POP) from the current literature. Materials and Methods: We carried out a search for electronic literature in the PubMed, Chinese National Knowledge Infrastructure, EMBASE, Wanfang Web of Science, Chinese Biomedical Literature Database, Cochrane Library, as well as Chinese VIP databases targeting articles published from inception to December 2020. Only randomized controlled trials (RCTs) were enrolled into the study. Alkaline phosphatase (ALP), visual analogue scale (VAS), serum phosphorus (S-P), bone gla protein (BGP), serum calcium (S-Ca) and bone mineral density (BMD) were the primary outcome variable. The total clinical effective rate along with the adverse drug reaction (ADR) were the secondary outcome variables. The meta-analysis was conducted using RevMan 5.3 and STATA 12.0. GRADE pro3.6.1 software was used for the assessment of evidence quality. Results: Overall, 20 RCTs focusing on 1911 patients were enrolled into the study. Our meta-analysis demonstrated that XLGB combined with ALE remarkably increased BMD (p < 0.001), BGP (p < 0.001), S-Ca (p < 0.001), S-P (p < 0.001) and effective rate (p < 0.001) than ALE alone in patients with POP. Moreover, ALP (p < 0.001) and VAS (p < 0.001) were overtly by decreased XLGB. However, XLGB combined with ALE would not markedly increase the rate of ADR in contrast with ALE alone (p = 0.499). Conclusion: The results of our study demonstrated that XLGB is a potential candidate for OP treatment. We recommend that rigorous, as well as high-quality trials involving large samples sizes should be conducted to confirm our findings.

Clinical Observation and Evaluation of Bushen Yiqi Huayu Decoction in Treatment of Primary Osteoporosis

Clinical Observation and Evaluation of Bushen Yiqi Huayu Decoction in Treatment of Primary Osteoporosis

Подходы к диагностике и лечению первичного остеопороза (в помощь практикующему врачу)

Back pain is a common medical and social problem that requires a doctor of any speciality to conduct a careful differential diagnosis and appropriate therapy. Commonly, both the doctor and the patient underestimate the importance of metabolic bone diseases in the development of acute and chronic pain. The article presents a clinical case of primary (postmenopausal) osteoporosis in a 66-year-old patient, female, with a clinically manifest form of generalized osteoarthritis. A detailed analysis of the algorithm of standard and additional diagnostic manipulations was conducted, indications for the prescription and treatment tactics concerning a drug for pathogenetic therapy were considered. The presence of the metabolic bone disease was suspected by back pain in an elderly female patient who had an onset at a late age (older than 50 years), and a decrease in height by more than 4 cm compared to the height at 25 years. The diagnosis was made clinically on the basis of X-ray data (vertebral compression fracture) and confirmed by the laboratory tests results. The risk of fracture was taken into account during treatment tactics determination. In particular, it was regarded as high in the presented case. KEYWORDS: osteoarthritis, back pain, osteoporosis, low-energy fracture, antiresorptive therapy, bisphosphonate. FOR CITATION: Kadyrova L.R., Bashkova I.B., Akarachkova E.S. Methods for the diagnosis and treatment of primary osteoporosis (in aid of a practicing physician). Russian Medical Inquiry. 2021;5(5):288–293 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-288-293.

Modern principles for the diagnosis and treatment of postmenopausal osteoporosis: a focus on bisphosphonates

The article presents the relevance of the problem of postmenopausal osteoporosis (OP) in modern medicine, due to the social and economic consequences of fractures. The pathogenetic mechanisms of its formation are highlighted, indicating that during postmenopausal women amid estrogen deficiency, there is a violation of bone remodeling processes with increased bone resorption and decreased bone formation. Modern recommendations of the pathogenetic therapy of OP are presented, in which it is noted that the drugs of the first choice are drugs of the bisphosphonate class (BF). The ability of BF to suppress the pathological resorption of bone tissue and stimulate bone formation determines their therapeutic effect in OP. One of the drugs of the BF class is alendronate. In the treatment with alendronate, the processes of resorption by osteoclasts are suppressed and the processes of bone metabolism are restored to the premenopausal level, microarchitectural disturbances and bone loss are prevented. It has been demonstrated that the processes of bone metabolism remain stable during prolonged treatment with alendronate for 10 years, while the accumulation of the drug in the bone does not lead to excessive suppression of bone metabolism, but rather remains at the premenopausal level. The data of international and Russian randomized placebo-controlled trials (RCTs) are presented, which indicate the high effectiveness of alendronate at a dose of 70 mg 1 time / week in the treatment of primary OP in postmenopausal women: it had a positive effect on bone mineral density (BMD), reduced pain and, as a result, reduced the restriction of physical activity of patients. Quite good tolerability of the drug was noted, side effects in the treatment group were comparable to those in the placebo group. An analysis of the action of alenadronate shows that it has an aftereffect within a 12-month period after the end of treatment in relation to the BMD of the spine.

Effects of bushen qianggu method for primary osteoporosis: A protocol for systematic review and meta-analysis.

Background:Primary osteoporosis (POP) is one of the most common orthopedic diseases with a high risk of fracture. Effective treatment of POP is of great significance to reduce the rate of disability and improve the quality of life. Bushen qianggu (BSQG) is a classical method of TCM in treating POP. However, there is no systematic review related to BSQG for POP. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSQG in the treatment of POP.Methods and analysis:Relevant randomized controlled trial literature evaluating the effect of BSQG on patients with POP will be obtained by searching the PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database, Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The bone mineral density value and the incidence of fractures will be accepted as the primary outcomes. The meta-analyses will be performed by using the RevMan 5.3.Results:This study will provide a comprehensive evaluation of the efficacy and safety of BSQG method for patients with POP.Conclusion:The conclusion of our systematic review will provide evidence to judge whether BSQG is an effective intervention for patients with POP.Trial registration number: 10.17605/OSF.IO/ZMX3W.

Fall Prevention and Anti-Osteoporosis in Osteopenia Patients of 80 Years of Age and Older: A Randomized Controlled Study.

ObjectiveTo evaluate the effects of two fall‐prevention and anti‐osteoporotic protocols in elderly patients with osteopenia (OPA).MethodsThe present randomized controlled study included patients with OPA (n =123). The age of these patients was ≥80 years old, with the mean age of 83.54 ± 2.99 years, and the male‐to‐female ratio was 2.97:1.00. Fall‐prevention guidance was given to all patients. Patients in the experiment group (n = 62) orally received 600 mg/d of calcium carbonate, 0.5 μg/d of alfacalcidol, and 70 mg/week of alendronate, while patients in the control group (n = 61) orally received 600 mg/d of calcium carbonate and 0.5 μg/d of alfacalcidol for 18 months. The grip strength, gait speed, bone turnover markers, serum calcium, serum phosphorus, parathyroid hormone (PTH), and bone mineral density were measured, and the Timed Up and Go (TUG) test and the chair rising test (CRT) were performed. Falls, fragility fractures, medication compliance, and side effects of the drugs were recorded.ResultsThe serum levels of bone turnover markers (type I procollagen amino‐terminal peptide [P1NP], type I collagen carboxyl terminal peptide [β‐CTx], and osteocalcin [OC]) decreased, while the bone mineral density of the lumbar spine and bilateral femoral neck increased after treatment in the experiment group (P < 0.05, P < 0.01). The rate of change in bone mineral density of the bilateral femoral neck was higher in the experiment group than the control group (3.43% vs 0.03%, P < 0.05; 2.86% vs −0.02%, P < 0.01). After treatment, the proportion of patients with increased hip T scores in the experiment group (66.1%, 41/62) was significantly higher than the proportion (35.0%, 21/60) in the control group (P = 0.001). The incidence of fall decreased in both groups after treatment compared to that before treatment (54.8% vs 33.9% and 54.1% vs 36.7%, respectively; P < 0.05). The incidence of fragility fractures was lower in the experiment group than the control group (8.1% vs 20.0%, P = 0.057). During the intervention period, the incidence of fragility fractures in patients who did not fall (3.8%, 3/79) was significantly lower than that in patients who fell (32.6%, 14/43) (P = 0.000). The risk of fragility fractures was significantly lower in patients who did not fall compared to patients who fell (relative risk: 0.117, 95% confidence interval: 0.035–0.384).ConclusionThe combination of alendronate sodium with alfacalcidol and calcium can significantly improve the bone mineral density of the lumbar spine and femoral neck. For older patients with OPA, subjectively paying attention to avoiding falls can significantly reduce the risk of fragility fractures.

Acupuncture and moxibustion for primary osteoporosis: An overview of systematic review.

Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial.To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality.A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain.Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.

Acupoint injection treatment for primary osteoporosis: A systematic review and meta-analysis of randomized controlled trials protocol.

Acupoint injection has currently received increasing attention as a treatment for primary osteoporosis (POP). A number of randomized controlled trials (RCTs) have reported that acupoint injection have some advantages in treatment of POP. However, no article has summarized the existing evidence. This study will evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP, so as to provide an important reference for clinical decision-making. RCTs of acupoint injection compared with conventional non-acupoint injection for POP were identified in searches of 7 databases from their inception to March 2019. All data were assessed and extracted by 2 authors independently. The risk of bias assessment recommended by the Cochrane Collaboration was used to assess the quality of the selected studies. Review Manager 5.3 (Cochrane Collaboration) was used to conduct meta-analysis for the efficacy and safety of acupoint injection. The results of this systemic review and meta-analysis will be submitted to a recognized journal for publication. This systemic review and meta-analysis will evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP. We hope this study can make a definitive conclusion for acupoint injection in the treatment of POP. PROSPERO (registration number CRD42019130890).

Acupuncture for primary osteoporosis: A network meta-analysis of randomized controlled trials protocol.

Background:A large number of randomized controlled trials (RCTs) have shown that acupuncture (ACU) has certain advantages over pharmacotherapies in the treatment of primary osteoporosis (POP). However, due to the diversity of ACU treatments, its relative effectiveness have not yet been studied and explained. Therefore, based on the network meta-analysis (NMA), this study will compare the differences in the efficacy of multiacupuncture in the treatment of POP, to provide a reference for clinical treatment.Methods:We will search PubMed, MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure (CHKD-CNKI), WANFANG database (Chinese Medicine Premier), Chinese Biomedical Literature database (CBM), and VIP for relevant RCTs of ACU treatments for POP, from their inceptions to January 2019. STATA 15.0 and GEMTC software will be used to perform a NMA. The evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the type 1 error rate will be assessed by trial sequential analysis (TSA).Results:The results of this review will be submitted to a recognized journal for publication.Conclusion:This proposed systematic review will evaluate the different advantages of various types of ACU in the treatment of POP.Registration:PROSPERO (registration number CRD42019122724).

Liuwei Dihuang Decoction for primary osteoporosis: A protocol for a systematic review and meta-analysis.

Primary osteoporosis (POP) is one kind of global disease, as a serious threat to human health. Liuwei Dihuang Decoction (LWDHD) has been recommended to treat osteoporosis alone or combined with medicine in China; however, its efficacy is unclear. The object of this systematic review and meta-analysis is to evaluate the efficacy and safety of LWDHD in the management of POP. We will search The Cochrane Library, Medline, PubMed, Elsevier, Springer, Web of Science, Ovid, WHO ICTRP, CNKI, CBM, VIP, and WanFang Database from their inception to February 2019. All randomized controlled trials (RCTs) of LWDHD for the treatment of POP will be included. The language is limited to Chinese and English. The fracture incidence will be accepted as the primary outcomes. Data synthesis, subgroup analysis, sensitivity analysis will be performed by using RevMan V.5.3.5 software. A high-quality synthesis of current evidence for the treatment of POP with LWDHD will be provided from efficacy and safety. This systematic review will generate evidence for judging whether LWDHD is an effective and safe intervention for POP or not. PROSPERO CRD 4201926066.

Persistence with brand versus generic oral bisphosphonates among newly treated osteoporosis patients: a retrospective cohort study in the French claims database

Introduction The first line of osteoporosis (OP) treatment is oral bisphosphonate (BP) and aims to reduce the risk of osteoporotic fracture. Although BP demonstrated his efficacy in preventing fractures, persistence with BP was estimated very low in previous studies in France and other countries. It has been proposed that persistence with generic BP formulations may be lower compared to brand formulations, due to changes of excipients reported to result in differences in disintegration time increasing the risk of upper gastrointestinal irritation. We aimed to compare the persistence with brand versus generic oral BPs. Methods We conducted a retrospective, comparative cohort study in the EGB (“Echantillon Generaliste des Beneficiaires”), a representative sample of the French Health Insurance claims database. We included all patients aged 50 and older, newly treated with oral BP (alendronic acid, ibandronic acid, risedronic acid or etidronic acid, without association with vitamin D) for primary osteoporosis between 01/01/2009 and 31/12/2015. Patients were followed from the initiation date until: switch (change from generic to brand drug and conversely, or change of BP molecule); discontinuation of BP (no new dispensation during a period greater than twice the expected duration of supply if taken as prescribed); or 12 months. Persistence was evaluated as time to discontinuation and as proportion of patients still on treatment at 6 and 12 months. Time to discontinuation and 6- and 12-month persistence were compared between patients who initiated treatment with generic and patients who initiated with brand BP, excluding patients who switched. Results In total, 3903 patients initiated an oral BP treatment for primary OP during the 7-year inclusion period, 1710 (44.0%) with generic BP and 2193 (56.0%) with brand BP. Mean age was comparable between the 2 groups: 70.8 (± 10.6) in “generic BP” group and 70.0 (± 10.4) in “brand BP” group. There were fewer women in the “generic BP” group than in “brand BP” group (respectively 87.8% and 90.3%; P = 0.01. 236 (13.8%) patients in “generic BP” group and 306 (14.0%) patients in “brand BP” group switched to the other BP group during the 12 months after initiation; 56 (3.3%) patients in the “generic BP” group and 175 (8.0%) patients in “brand BP” group have changed to another BP molecule, respectively. After exclusion of patients who switched, 6- and 12-month persistence were not statistically different between the 2 groups: respectively 43.9% and 33.8% in “generic BP” group and 41.7% and 31.3% in “brand BP” group (P = 0.22 and 0.14 respectively for 6- and 12-month persistence). Mean time to discontinuation was 185.6 days (± 138.3) in “generic BP” group and 183.1 days (± 138.1) in “brand BP” group. Conclusions There were no differences in persistence with brand or generic BP in this population. Low persistence rates in our analysis are consistent with results of other studies, and confirm that discontinuation of BP treatment is currently a public health concern. The reasons for discontinuation require further investigation, to inform shared decision-making in treatment choice and strategies to support long-term BP use.

Systemic evaluation and Meta-analysis of Xianling Gubao capsule in treatment of primary osteoporosis in randomized controlled trials

To evaluate the efficacy and safety of Xianling Gubao capsule in the treatment of osteoporosis (OP). Eight Chinese and English databases were retrieved (from establishment to February 2017), and clinical trials were screened according to the preset inclusion criteria and exclusion criteria. Then risk assessment tools were used for quality evaluation of the studies, and data extraction and analysis were conducted by using RevMan 5.3 software for Meta-analysis. A total of 1 895 articles were retrieved, and finally 54 studies were included. The total sample number was 5 030, including 2 543 cases in experimental group and 2 487 cases in control group. As compared with CT (routine therapy) intervention, Xianling Gubao capsules showed higher SOP efficiency and improved bone mineral density in patients with OP [MD=0.08, 95%CI (0.06, 0.10)]. As compared with control group, Xianling Gubao capsule+CT showed higher efficiency in PMOP and SOP, increased bone mineral density in OP patients [MD=0.04, 95%CI (0.03, 0.05)], POP patients [MD=0.08, 95%CI (0.05, 0.10)], and SOP patients [MD=0.06, 95%CI (0.05, 0.07)], relieved osteoporotic pain in OP patients [MD=-0.93,95%CI(-1.16, -0.70), increased alkaline phosphatase level in OP patients [MD=7.53, 95%CI (5.91, 9.14), blood calcium in OP patients [MD=0.03, 95%CI (0.01, 0.06)], and osteocalcin level in OP patients [MD=4.09, 95%CI (3.20, 4.98)], and increased serum phosphorus level in SOP patients [MD=0.03, 95%CI (0.00, 0.05)]. The main adverse reactions reported were liver injury and gastrointestinal symptoms. Xianling Gubao capsule alone or combined use with other medicines had better efficacy than western medicine alone in the treatment of osteoporosis. However, because of potential bias in the included studies, more high-quality randomized controlled trials would be needed to improve the level of evidence.