Ｒesearch Progress in The Clinical Efficacy Of Traditional Chinese Medicine On The Treatment Of Postmenopausal Osteoporosis

 

 

 

 

Abstract:

 

Postmenopausal osteoporosis ( PMOP) is a metabolic disease result ing from decreased estrogen secretion and an imbalance in bone metabolism and absorption,significantly impacting the quality of life of middle-aged and elderly women． However,due to the intricate pathogenesis of PMOP,the precise mechanism remains elusive． The treatment of PMOP has become a matter of great concern in society． Numerous studies have shown that traditional Chinese medicine has achieved good therapeutic effects on improving bone mineral density and estrogen levels in patients with PMOP,as well as on alleviating pain symptoms． This article reviews the relevant Chinese and foreign literature in the treatment of PMOP with traditional Chinese medicine in the past 5 years,weighing the clinical efficacy of traditional Chinese medicine in treating PMOP from multiple aspects such as patient pain status,bone mineral density,and bone metabolism indicators． The mechanism of traditional Chinese medicine in the treatment of PMOP is further explored and summarized from the aspects of ＲUNX2,BMP-2,ＲANKL /ＲANK /OPG regulatory axis,MAPK, NF-κB pathway,and Wnt /β-catenin pathway．

 

Keywords: traditional Chinese medicine; postmenopausal osteoporosis; bone metabolism; mechanism

 

Cistanche Herbal Supplements For Bone Metabolism

 

Bone metabolism is a lifelong dynamic process. Bone mass reaches its peak during puberty and then gradually declines. After menopause, estrogen levels drop drastically [1]. This accelerates bone loss in postmenopausal women, destroys bone homeostasis, and causes the "osteoblast-osteoclast" balance composed of osteoblasts (OB) and osteoclasts (OC) to be broken, causing a high rate of bone remodeling and leading to postmenopausal osteoporosis (PMOP) [2]. Currently, there are a large number of PMOP patients worldwide, and how to treat PMOP has become a key prevention and treatment issue in various countries [3]. Currently, commonly used drugs include bisphosphonates and selective estrogen receptor modulators [4-5], which can improve PMOP symptoms, but long-term use may increase the risk of cardiovascular disease [6-7].
Traditional Chinese medicine usually classifies PMOP as "bone atrophy" and "bone arthritis" [8], and believes that its onset may be related to the "kidney-Tiangui-Chongren-Baogong physiological" axis [9]. In recent years, traditional Chinese medicine has achieved good results in the prevention and treatment of PMOP. [10] Therefore, this article summarizes the commonly used traditional Chinese medicine therapies and their mechanisms of action to help clinical workers better treat PMOP.

 

Clinical efficacy of traditional Chinese medicine in the treatment of postmenopausal osteoporosis

 

1.1 Clinical efficacy of traditional Chinese medicine internal and external treatments for PMOP

Clinical studies have found that traditional Chinese medicine has better efficacy in the treatment of PMOP than conventional Western medicine. Qing'e Pills, a commonly used medicine for the treatment of PMOP, [11] can better improve the bone mineral density (BMD) of patients. Xie Lihua et al. [12] used Xuling Jiangu Granules to treat PMOP, and its efficacy was better than that of the Western medicine group. Chen Tianpeng et al. [13] found that Qianggu
yin can improve bone metabolism. Li Zhikui et al. [14] found that the Bushen Huoxue Decoction combined with estrogen to treat PMOP can improve serum interleukin (IL)-6, tumor necrosis factor α (TNF-α) and bone metabolites alkaline phosphatase (ALP), osteocalcin (BGP), and osteoprotegerin (OPG) levels.

The Bushen Yigu Decoction combined with calcium carbonate D3 has better efficacy than the conventional treatment group [15]. In the experiment conducted by Wang Xinmei et al. [16], compared with conventional Western medicine treatment, the Bushen Tiaochong formula can improve the levels of bone markers such as total bone type I procollagen amino acid chain (PINP) and BGP.
In evidence-based medicine research, it was found that traditional Chinese medicine combined with other therapies had better efficacy than single therapy [17]. In the study conducted by Cui Xin et al. [18], compared with conventional treatment, moxibustion combined with conventional treatment can effectively improve the symptoms of PMOP patients. Clinical RCT studies have found that acupuncture can improve PMOP symptoms such as back pain, weakness in the waist and knees, cramps in the lower limbs, and difficulty walking [19]. In the experiment conducted by Liang Zhuang et al. [20], warm acupuncture combined with Yougui Pills can effectively improve patients' BMD, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2) levels compared with warm acupuncture alone. The combination of warm acupuncture and Qing'e Pills was compared with Qing'e Pills alone, and the combined use was superior to the single use in improving bone metabolism indicators [21]. The above specific data are shown in Table 1.

 

Table 1 Summary of traditional Chinese treatment for PMOP

 

Group Name	Sample Size (n)	Treatment	Outcome Measures	References
Traditional Chinese Medicine + Western Medicine	19	BMD increase and improvement in bone metabolism	(BMD increase, Ca, Zn, Mg, P, BGP, PINP, CTX)	[1]
Traditional Chinese Medicine + Western Medicine	53	BMD increase and improvement in bone metabolism	(BMD increase, Ca, Zn, Mg, P, BGP, PINP, CTX)	[2]
Traditional Chinese Medicine + Western Medicine	57	BMD increase and improvement in bone metabolism	(BMD increase, Ca, Zn, Mg, P, BGP, PINP, CTX)	[3]
Traditional Chinese Medicine + Western Medicine	40	BMD increase and improvement in bone metabolism	(BMD increase, Ca, Zn, Mg, P, BGP, PINP, CTX)	[4]

 

1. 2 Evidence-based medical research and side effects discussion of traditional Chinese medicine therapy

A large number of meta-analysis studies have found that traditional Chinese medicine is better than conventional Western medicine in treating PMOP. Wang Qingying et al.[22] found through meta-analysis that the traditional Chinese medicine group was better than the western medicine group in improving BMD.
A meta-analysis by Jinyu Li et al.[23] found that Duhuo Jisheng Decoction had better efficacy than Western medicine and the traditional Chinese medicine group. In addition, a meta-analysis by Chen Taihong et al. [24] found that liver and kidney tonifying traditional Chinese medicine can effectively increase E2 levels in the treatment of PMOP. In a meta-analysis involving multiple studies by Minghui Luo et al. [25], it was found that Xianling Gubao Capsule improved serum ALP and BGP levels more significantly than conventional Western medicine treatment.
At the same time, in a number of meta-analysis studies [25-37], the traditional Chinese medicine group has more advantages than conventional Western medicine treatment in improving PMOP syndrome scores and clinical symptoms. The data of more studies are shown in Table 2.

 

Table 2 Meta analysis data of clinical research on traditional Chinese medicine treatment of PMOP

Author	Study Subjects	Intervention (Experiment vs. Control)	Main Results	Adverse Reactions	References
Wang Qingchun et al.	Meta-analysis of 8 studies, 905 PMOP patients	Strong bone capsule vs. Western medicine standard therapy	Improvement in lumbar spine and hip BMD; BMD differences favor the experimental group	Dry mouth, palpitations, mild adverse reactions	[2]
Jinyu Liu et al.	Meta-analysis of 7 studies, 841 PMOP patients	Bushen-Yisui therapy (Traditional Chinese Medicine) vs. Western medicine	Increased BMD, improved E2 levels, and better outcomes in the experimental group	None reported	[3]
Minghui Luo et al.	Meta-analysis of 10 studies, 1,480 PMOP patients	Xianling Gubao capsule vs. Western medicine	Improved clinical outcomes; increased BMD, serum ALP, and BGP levels favor the experimental group	None reported	[24]
Fan Huang et al.	Meta-analysis of 10 studies, PMOP patients	Hole repair therapy vs. Western medicine	Improved BMD, serum BGP; decreased serum ALP favor the experimental group	None reported	[25]
Wang Qingchun et al.	Meta-analysis of 7 studies, 1,016 PMOP patients	TCM therapy combined with Vitamin D	Clinical efficacy in improving BMD, bone turnover markers, and pain	6 cases of mild adverse reactions, including gastrointestinal discomfort	[27]
Zhao Enyi et al.	Meta-analysis of 10 studies, 1,480 PMOP patients	Bushen-Huoxue therapy vs. calcium and Vitamin D	Improved BMD, blood calcium levels, and clinical indicators favor the experimental group	None reported	[28]
Zhang Xiaoyu et al.	Meta-analysis of 10 studies, 1,126 PMOP patients	Bushen therapy vs. calcium and Vitamin D	Suppression of bone resorption, improved outcomes in experimental group	None reported	[29]
An Fang et al.	Meta-analysis of 7 studies, 2,687 PMOP patients	Bushen-Yisui therapy vs. Western medicine	Reduced bone resorption markers (e.g., β-CTX); improved bone formation markers	7 mild adverse reactions reported	[30]
井美娜等	Meta-analysis of 9 studies, 1,426 PMOP patients	Bushen-Yisui therapy vs. calcium and Vitamin D	Increased BMD, improved bone metabolism markers favor experimental group	None reported	[31]
桂萍等	Meta-analysis of 10 studies, 2,491 PMOP patients	An Shen therapy vs. Western medicine	Increased BMD; improved clinical symptoms in experimental group	None reported	[2]
王清萍等	Meta-analysis of 12 studies, 1,128 PMOP patients	Liuwei Dihuang pill vs. Western medicine	Improved BMD, reduced bone resorption markers, better outcomes in experimental group	6 mild adverse reactions	[3]
陈凯等	Meta-analysis of 12 studies, 915 PMOP patients	Xianling Gubao capsule vs. Western medicine	Increased BMD, lower β-CTX, improved outcomes favor experimental group	1 mild adverse reaction reported	[4]
安一方等	Meta-analysis of 10 studies, PMOP patients	Xianling Gubao capsule vs. Western medicine	Improved BMD; reduced pain scores (VAS, NRS) favor experimental group	1 mild adverse reaction reported	[5]
王雅等	Meta-analysis of 7 studies, 905 PMOP patients	Bushen-Yisui therapy vs. Western medicine	Increased BMD; improved E2 levels favor experimental group	None reported	[6]

 

This study summarized the data of nearly 20,000 PMOP patients and found 101 patients with adverse reactions, of which 65 cases were gastrointestinal reactions such as constipation, diarrhea, and stomach discomfort. Other adverse reactions included dry mouth, oral ulcers, and blood stasis at the acupuncture site. Compared with the increased risk of cardiovascular diseases and cancer caused by Western estrogen replacement therapy [38], these serious adverse reactions were not found in traditional Chinese medicine. It can be seen that traditional Chinese medicine has the advantage of high safety in the treatment of PMOP and has good application prospects.