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Determination of the Combined Effects of Asian Herbal Medicine with Calcium and/or Vitamin D Supplements on Bone Mineral Density in Primary Osteoporosis: A Systematic Review and Meta-Analysis

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A Correction to this article was published on 21 March 2024

This article has been updated

Abstract

Summary

Our review of 52 RCTs from 5 databases suggests a tendency for notable improvement in BMD when combining herbal medicine with supplements (calcium and vitamin D variants) compared to supplement monotherapy in primary osteoporosis. However, caution is needed in interpreting results due to substantial heterogeneity among included studies.

Purpose

To conduct a systematic review and meta-analysis to determine whether herbal medicine (HM) plus supplements such as calcium (Ca) or vitamin D (Vit.D) improves bone mineral density (BMD) compared to supplements alone in primary osteoporosis (OP) patients.

Methods

We searched 5 databases for randomized controlled trials (RCTs) using HMs with supplements (Ca or Vit.D variants) as interventions for primary OP patients published until August 31, 2022. Meta-analysis using BMD score as the primary outcome was performed using RevMan 5.4 version. Risk of bias in the included studies was assessed useing RoB 2.0 tool.

Results

In total, 52 RCTs involving 4,889 participants (1,408 men, 3,481 women) were included, with average BMD scores of 0.690 ± 0.095 g/cm2 (lumbar) and 0.625 ± 0.090 g/cm2 (femoral neck). As a result of performing meta-analysis using BMD scores for all 52 RCTs included in this review, combination of HMs with Ca and Vit.D variants improved the BMD score by 0.08 g/cm2 (lumbar, 38 RCTs, 95% CI: 0.06–0.10, p < 0.001, I2 = 97%) and 0.06 g/cm2 (femoral neck, 19 RCTs, 95% CI: 0.04–0.08, p < 0.001, I2 = 92%)compared to controls. However, statistical significance of the lumbar BMD improvement disappeared after adjusting for potential publication bias.

Conclusion

Our data suggest that combining of HM and supplements tends to be more effective in improving BMD in primary OP than supplements alone. However, caution is needed in interpretation due to the reporting bias and high heterogeneity among studies, and well-designed RCTs are required in the future.

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Data availability

All original data used in this study are presented in the Reference section of this manuscript and are summarized in Table 2. All data supporting the findings of this review are available from the corresponding author (E-J Lee).

Change history

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Acknowledgements

This workstudy was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. Ministry of Education, Science and Technology (NRF-2021R1A2C2013483).

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Authors and Affiliations

  1. Colleage of Korean Medicine, Daejeon University, 62, Daehak-Ro, Dong-Gu, Daejeon, 34520, Republic of Korea

    Hee-Joo Park, Min-Gyeong Kim & Young-Seo Yoo

  2. KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea

    Boram Lee

  3. Institute of Bioscience and Integrative Medicine, Daejeon University, 62 Daehak-Ro, Dong-Gu, Daejeon, 34520, Republic of Korea

    Yu-Jin Choi

  4. Reseacrch Center for CFS/ME in Daejeon University, 75, Daedukdae-Ro 176, Seo-Gu, Daejeon, 35235, Republic of Korea

    Chang-Gue Son

  5. Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, 62, Daehak-Ro, Dong-Gu, Daejeon, 34520, Republic of Korea

    Eun-Jung Lee

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Contributions

Conceptualization and study design: Chang-Gue Son, and Eun-Jung Lee.

Methodology: Hee-Joo Park, Min-Gyeong Kim, Young-Seo Yoo, Boram Lee, and Yu-Jin Choi

Formal analysis and investigation: Hee-Joo Park, Min-Gyeong Kim, and Young-Seo Yoo

Writing - original draft preparation: Hee-Joo Park, and Eun-Jung Lee

Writing - review and editing: Hee-Joo Park, Chang-Gue Son, and Eun-Jung Lee

Funding acquisition: Eun-Jung Lee

Resources and Supervision: Eun-Jung Lee

Corresponding author

Correspondence to Eun-Jung Lee.

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This article does not contain any studies involving human participants or animals.

Conflicts of Interest

Hee-Joo Park, Min-Gyeong Kim, Young-Seo Yoo, Boram Lee, Yu-Jin Choi, Chang-Gue Son, and Eun-Jung Lee declare that they have no conflict of interest.

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The original online version of this article was revised: In this article the author’s name Boram Lee was incorrectly written as Bo-Ram Lee.

Supplementary Information

Below is the link to the electronic supplementary material.

198_2024_7061_MOESM1_ESM.tif

Supplementary file1 Supplementary Fig. 1. Effects of HM combined with Ca and Vit.D variants on BMD improvement in primary OP with Fx. at the lumbar spine. HM: herbal medicine, Ca: calcium, Vit.D: vitamin D, BMD: bone minrenal density, OP: osteoporosis, Fx.: fracture. (TIF 1213 KB)

198_2024_7061_MOESM2_ESM.tif

Supplementary file2 Supplementary Fig. 2. Effects of HM combined with Ca and Vit.D variants on BMD improvement in primary OP with Fx. at the femoral neck. HM: herbal medicine, Ca: calcium, Vit.D: vitamin D, BMD: bone minrenal density, OP: osteoporosis, Fx.: fracture. (TIF 1105 KB)

198_2024_7061_MOESM3_ESM.tif

Supplementary file3 Supplementary Fig. 3. Mean difference of BMD between intervention group compared to control group (a) Mean difference of BMD between HM+Ca+Vit.D variants and Ca+Vit.D variants by subgroup (b) Mean difference of BMD between HM+Vit.D variants and Vit.D variants by subgroup. BMD: bone minrenal density, HM: herbal medicine, Ca: calcium, Vit.D: vitamin D, PMOP: postmenopausal osteoporosis, Senile: senile osteoporosis, m: month. (TIF 1076 KB)

198_2024_7061_MOESM4_ESM.tif

Supplementary file4 Supplementary Fig. 4. Subgroup analysis of BMD scores between HM+Supplements and Supplements Based on type of Supplements. BMD: bone minrenal density, HM: herbal medicine, C.: control, Ca: calcium, Vit.D: vitamin D. (TIF 3700 KB)

198_2024_7061_MOESM5_ESM.tif

Supplementary file5 Supplementary Fig. 5. Subgroup analysis of lumbar spine BMD scores between HM+Supplements and Supplements Based on Supplement types. BMD: bone minrenal density, HM: herbal medicine, C.: control, Ca: calcium, Vit.D: vitamin D. (TIF 1784 KB)

198_2024_7061_MOESM6_ESM.tif

Supplementary file6 Supplementary Fig. 6. Subgroup analysis of femoral neck BMD scores between HM+Supplements and Supplements Based on Supplement types. BMD: bone minrenal density, HM: herbal medicine, C.: control, Ca: calcium, Vit.D: vitamin D. (TIF 1988 KB)

198_2024_7061_MOESM7_ESM.tif

Supplementary file7 Supplementary Fig. 7. Risk of bias assessment of included RCTs. RCT: randomized controlled trial. (TIF 3401 KB)

198_2024_7061_MOESM8_ESM.tif

Supplementary file8 Supplementary Fig. 8. Funnel plot of effects of HM combined with supplements on BMD improvement (a) HM+Ca+Vit.D variants vs Ca+Vit.D variants (Lumbar) (b) HM+Ca+Vit.D variants vs Ca+Vit.D variants (Femoral neck) (c) HM+Vit.D variants vs Vit.D variants (Lumbar) HM: herbal medicine, BMD: bone mineral density, Ca: calcium, Vit. D: vitamin D, PMOP: postmenopausal osteoporosis, Senile: senile osteoporosis. (TIF 918 KB)

198_2024_7061_MOESM9_ESM.tif

Supplementary file9 Supplementary Fig. 9. Effects of HM combined with Ca and Vit.D variants on BMD improvement at the lumbar spine including RCTs of Jadad score < 2. HM: herbal medicine, Ca: calcium, Vit.D: vitamin D, BMD: bone mineral density, RCT: randomized controlled trial, *: RCT of Jadad score < 2. (TIF 1971 KB)

198_2024_7061_MOESM10_ESM.tif

Supplementary file10 Supplementary Fig. 10. Effects of HM combined with Ca and Vit.D variants on BMD improvement at the femoral neck including RCTs of Jadad score < 2. HM: herbal medicine, Ca: calcium, Vit.D: vitamin D, BMD: bone mineral density, RCT: randomized controlled trial, *: RCT of Jadad score < 2. (TIF 1573 KB)

198_2024_7061_MOESM11_ESM.tif

Supplementary file11 Supplementary Fig. 11. Effects of XLGB capsule combined with Ca and Vit.D variants on BMD improvement at the lumbar spine including RCTs of Jadad score < 2. XLGB: xianling gubao, Ca: calcium, Vit.D: vitamin D, BMD: bone mineral density, RCT: randomized controlled trial, *: RCT of Jadad score < 2. (TIF 1015 KB)

198_2024_7061_MOESM12_ESM.tif

Supplementary file12 Supplementary Fig. 12. Effects of BSHX decoction combined with Ca and Vit.D variants on BMD improvement including RCTs of Jadad score < 2. BSHX: bushen huoxue, Ca: calcium, Vit.D: vitamin D, BMD: bone mineral density, RCT: randomized controlled trial, *: RCT of Jadad score < 2. (TIF 1866 KB)

Supplementary file13 (DOCX 91 KB)

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Park, HJ., Kim, MG., Yoo, YS. et al. Determination of the Combined Effects of Asian Herbal Medicine with Calcium and/or Vitamin D Supplements on Bone Mineral Density in Primary Osteoporosis: A Systematic Review and Meta-Analysis. Osteoporos Int (2024). https://doi.org/10.1007/s00198-024-07061-0

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