Additional effects of herbal medicine combined with bisphosphonates for primary osteoporosis: a systematic review and meta-analysis

Young-Seo Yoo; Min-Gyeong Kim; Hee-Joo Park; Min-Young Chae; Yu-Jin Choi; Chae-Kun Oh; Chang-Gue Son; Eun-Jung Lee

doi:10.3389/fphar.2024.1413515

Additional effects of herbal medicine combined with bisphosphonates for primary osteoporosis: a systematic review and meta-analysis

Front Pharmacol. 2024 Sep 13:15:1413515. doi: 10.3389/fphar.2024.1413515. eCollection 2024.

Authors

Young-Seo Yoo^#¹, Min-Gyeong Kim^#¹, Hee-Joo Park¹, Min-Young Chae², Yu-Jin Choi³, Chae-Kun Oh⁴, Chang-Gue Son³, Eun-Jung Lee²

Affiliations

¹ College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.
² Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.
³ Institute of Bioscience and Integrative Medicine, Department of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.
⁴ Department of Herbal Formula, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.

^# Contributed equally.

Abstract

Background: Osteoporosis (OP) is a significant medical issue associated with population aging. Recent research on herbal medicines (HMs) for OP has been increasing, with these therapies sometimes used in conjunction with bisphosphonates (BPs), the standard treatment for OP. We conducted a systematic review and meta-analysis to evaluate the effects of combining HMs with BPs on improving bone mineral density (BMD) in patients with primary OP.

Methods: We searched nine databases-PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Wanfang, KISS, Kmbase, Science On, and Oasis-up to 31 August 2023. We selected randomized controlled trials (RCTs) comparing BMD between HMs plus BPs and BPs alone in primary OP. A meta-analysis with BMD as the primary outcome was performed using RevMan version 5.4. Study quality and evidence certainty were assessed through Cochrane's risk of bias2 and GRADE.

Results: Out of 43 RCTs involving 4,470 participants (mean age 65.8 ± 6.6 years), 35 RCTs with 3,693 participants were included in the meta-analysis. The combination of HMs and BPs was found to be more effective in improving BMD compared to BPs alone, with improvements of 0.10 g/cm² at the lumbar spine (33 RCTs, 95% CI: 0.07-0.12, p < 0.001, I² = 93%) and 0.08 g/cm² at the femoral neck (20 RCTs, 95% CI: 0.05-0.12, p < 0.001, I² = 94%), though this result was associated with high heterogeneity, high risk of bias, and very low certainty of evidence.

Conclusion: Our data suggest the possibility that combining HMs with BPs may improve BMD in primary OP more effectively than using BPs alone. However, the results should be interpreted with caution due to the high heterogeneity and low quality of the studies included in the review. Therefore, further well-designed RCTs are needed to confirm these findings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023392139.

Keywords: bisphosphonates; bone mineral density; combination therapy; herbal medicines; primary osteoporosis.

Publication types

Systematic Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. NRF-2021R1A2C2013483).