Systematic Review And Meta-analysis Of Acupuncture And Moxibustion In Treatment Of Primary Osteoporosis

Objective:The randomized controlled trials of acupuncture and moxibustion for primary osteoporosis were searched,and systematic review and meta-analysis were carried out to evaluate the effectiveness and safety of acupuncture alone or combined with drugs in the treatment of Primary Osteoporosis to provide evidence-based medical evidence for treatment strategies.Methods:1.Based on search strategy and formula,the major Chinese and English databases at home and abroad were searched systematically,to collect the RCTs of acupuncture and moxibustion for primary osteoporosis.2.According to inclusion and exclusion criteria,the trials which met the requirements were selected,and information extraction was performed.The bias risk assessment was carried out based on Cochrane evaluator’s manual.3.The interventions included(1)Acupuncture and moxibustion VS drugs,(2)Acupuncture and moxibustion + medicine VS medicine,(3)Acupuncture and moxibustion + herbal medicine VS herbal medicine,(4)Acupuncture and moxibustion+ herbal medicine + medicine VS herbal medicine + medicine.The outcome measurements included total effective rate、VAS、BMD、BGP、ALP、symptom score and adverse reactions.4.Revman 5.3 software was used for statistical analysis,forest plots were drawn and interpreted,and publication bias was analyzed using funnel plots.Sensitivity analysis was performed if there was high heterogeneity between studies.The GRADE system was used to analyze the quality of evidence and the recommended strength of each outcome measurement.Result:1.A total of 2265 patients were enrolled in 28 studies,including 1135 patients in the treatment group and 1130 patients in the control group.The sample size ranged from 20 to 96,and the course of treatments ranged from 28 to 180 days.2.The comparison between acupuncture group and drug group was performed in 12 studies,and 6 outcome measurements were quantitatively analyzed as follows:total effective rate’s OR=2.74,95% CI=[1.84,4.08],P<0.01;BMD’s MD=0.05,95%CI=[0.02,0.07],P<0.01;VAS’s MD=-1.77,95%CI=[-1.95,-1.58],P<0.01;symptom score’s MD=-2.92,95% CI=[-3.43,-2.42],P<0.01.Acupuncture group were superior to the drug group in improving the total effective rate,reducing the score of pain and symptoms and increasing bone density.BGP’s MD=-0.43,95%CI=[-0.98,0.12],P=0.13;adverse reaction’s MD=0.72,95%CI=[0.32,1.62],P=0.42;There was no significant advantage in treatment group in improving serum BGP level and reducing adverse reactions.GRADE evaluation: total effective rate、BMD were class B evidence,VAS、symptom score、BGP、ADR were class C evidence.3.The comparison between acupuncture and moxibustion + medicine group and medicine group was carried out in 9 studies,and 6 outcome measurements were quantitatively analyzed as follows: total effective rate’s OR=3.98,95%CI=[2.11,7.51],P<0.01;BMD’s MD=0.06,95%CI=[0.02,0.11],P<0.01;VAS’s MD=-1.12,95%CI=[-1.63,-0.61],P<0.01;symptom score’s MD=-3.07,95%CI=[-4.18,-1.96],P<0.01;Treatment group has advantages in improving total effective rate,reducing the score of pain and symptoms,and increasing bone density.BGP’s MD=-0.43,95%CI=[-2.03,1.18],P=0.60;ALP 的 MD=-2.32,95%CI=[-4.74,0.09],P=0.06,but the treatment group had no significant advantages in improving serum BGP and ALP level.GRADE evaluation: total effective rate was class B evidence,BMD、VAS、BGP were class C evidence,symptom score、ALP were class D evidence.4.Comparison between acupuncture and moxibustion + traditional Chinese medicine group and traditional Chinese medicine group was performed in 3 studies,and 3 outcome measurements were quantitatively analyzed as follows: total effective rate’s OR=3.86,95% CI=[2.19,6.81],P<0.01;BMD’s MD=0.07,95% CI= [0.06,0.07],P<0.01.Treatment group had advantages in improving the total effective rate,reducing the score of pain and symptoms,and increasing bone density.VAS’s MD=-0.14,95%CI=[-1.57,1.28],P=0.84,but the treatment had not obvious advantage in reducing VAS.GRADE evaluation: total effective rate was class C evidence,BMD and VAS were D evidence.5.Comparison between Acupuncture and moxibustion + traditional Chinese medicine + medicine group and traditional Chinese medicine + medicine group was carried out in 4 studies,and 3 outcome measurements were quantitatively analyzed as follows: total effective rate’s OR=4.17,95% CI=[2.29,7.60],P<0.01;BMD’s MD=0.07,95% CI=[0.06,0.08],P<0.01;ALP’s MD=-10.04,95% CI=[-12.18,-7.89],P<0.01.The treatment group had advantages in improving the total effective rate,increasing bone density and improving serum ALP level.GRADE evaluation:total effective rate was class B evidence,BMD and VAS were class C evidence.Conclusion:This study shows that acupuncture and moxibustion or combined drug therapy have significant advantages over the drug group in improving the total clinical effective rate,reducing the pain score and symptom score,increaseing bone mineral density.However,there were no obvious advantages in improving serum BGP and ALP and reducing the incidence of adverse reactions.The Meta-analysis and GRADE evidence evaluation show that acupuncture can improve clinical symptoms,increase bone strength and improve the quality of life of patients to a certain extent.It is a safe and effective treatment method in clinics.Meta-analysis is a secondary study based on clinical RCT which belongs to the highest level of evidence.GRADE can evaluate the quality of evidence and the recommended strength,so the results of this study have clinical values.Due to the low quality of literature included in this study,some studies with large sample and highquality should be carried out in order to reach a more objective and reliable conclusion,to better provide a reference for treatment strategies.