Review question:

Are Chinese herbal medicines beneficial for treating primary osteoporosis?

Nursing Implications:

Osteoporosis is a common public health problem all over the world. Additionally, osteoporosis-related injuries are accompanied by high rates of morbidity and mortality. It is therefore important to establish which methods are most beneficial for treating primary osteoporosis and it is thought that Chinese herbal medicines may be an effective option.

Review Characteristics:

The review examined 108 randomized clinical trials involving 10,655 participants diagnosed with primary osteoporosis or osteopenia, regardless of age, gender, or ethnic origin. Interventions included single herbs, combinations of herbs, or Chinese proprietary medicines. The following comparisons were examined: Chinese herbal medicines versus placebo, no intervention, or conventional medicine; or Chinese herbal medicine plus conventional medicine were compared with conventional medicine. Only 27 trials reported methods of random allocation. Ten trials reported having used double-blinding for the outcome assessment; two used a pre-trial estimation of same size and reported performing intention-to-treat analysis; 19 trials documented withdrawals. Thirty-eight trials did not report on the baseline comparability of groups in detail.

Summary of Key Evidence:

When compared with placebo in three trials, Chinese herbal medicines were associated with a significant increase in bone mineral density (BMD). For example, the Migu decoction treatment produced a significant increase in BMD of the lumbar spine (mean difference (MD) 0.16g/cm³; 95% confidence interval (CI) 0.06 to 0.26).

When compared with no intervention, two trials showed Chinese herbal medicine to be significantly effective in increasing BMD. For example, Qianggu soft extract treatment produced a significant increase in BMD of the femoral neck (MD 0.09g/cm³; 95% CI 0.03 to 0.13).

When compared with conventional medicine, 23 trials showed that Chinese herbal medicines were significantly effective in increasing BMD. Compared with calcium gluconate, Qianggu soft extract treatment resulted in a significant increase in BMD of the femoral neck (MD 0.07g/cm³; 95% CI 0.02 to 0.12). Of the 61 trials, 20 reported the improvement of lumbago.

When comparing Chinese herbal medicines plus western medication with western medication alone in 48 trials, 26 showed better effects in increasing BMD. Compared with Caltrate, the Xianlinggubao capsule plus Caltrate produced a significant increase in BMD of the femoral neck (MD 0.30g/cm³; 95% CI 0.25 to 0.35).

The included studies were small in sample size, suffered from various biases, and tested different Chinese herbal medicines.

Best Practice Recommendations:

The review suggests that the benefit of some Chinese herbal medicines may have effects in improving BMD. However, due to a predominance of low quality evidence in this field, further more methodologically rigorous studies are needed.

Summary Authors

Jing Song, RN and Aihua Zhang, PhD, RN

Jing Song, RN and Aihua Zhang, PhD, RN
Associate Professors
School of Nursing
Taishan Medical University
Chang cheng Road. Taian City, Shandong Province, P.R. China.

Both are members of the Cochrane Nursing Care Field (CNCF).