Evaluating combined acupuncture and antiresorptive therapy in Chinese women with postmenopausal osteoporosis: a systematic review and network meta-analysis
Abstract
Background: Postmenopausal osteoporosis (PMOP) is a common metabolic disorder in middle-aged and older women, leading to fractures, disability, and increased mortality. Current treatments include bisphosphonates (BPs), calcitonin (CT), vitamin D (VD), and acupuncture (Acu), often used in combination, but comparative evidence on different combined strategies remain limited.
Objective: To systematically compare the efficacy and safety of acupuncture combined with various medications for PMOP, supporting evidence-based clinical decisions.
Methods: We searched eight databases from inception to April 11, 2026 for randomized controlled trials (RCTs) evaluating acupuncture plus pharmacotherapy for PMOP. Primary outcomes included lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD), clinical efficacy, Traditional Chinese Medicine (TCM) syndrome scores, and Visual Analog Scale (VAS) pain scores. Secondary outcomes were procollagen type I N-terminal propeptide (PINP), C-terminal telopeptide (CTX), estradiol (E2), alkaline phosphatase (ALP), and osteocalcin (OCN). A Bayesian network meta-analysis was performed, ranking treatments by surface under the cumulative ranking curve (SUCRA).
Results: We included 112 RCTs (9, 908 patients, 83 treatment strategies). For LS-BMD, Calcitriol (Cal)_Electroacupuncture (ElecAcu) ranked highest. For FN-BMD, CT_VD_Traditional Chinese Medicine (TCM)_Fire dragon moxibustion (FDMox) (without BP) and CT_VD_BP_TCM_Acu (with BP) were best.…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 9 participants or records.
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