Effects of Chinese herbal formula Erxian decoction for treating osteoporosis: a systematic review.

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Salmon Calcitonin 1 endocrinologydiseasesdrugs
calcitriol 21 endocrinologydiseasesdrugs
osteoporosis 38 endocrinologydiseases
testosterone 2 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
Salmon Calcitonin 25480 Gu[26]70 (35/35)EG: 61.2±5.6CG: 60.4±5.8Postmenopausal womenEXD (a dose/d, Bid, oral administration) + CG Salmon Calcitonin (50 IU every day, intramuscular injection)3 monthsBMD (LSALP, BGP, CT, E2Gao[27]78 (39/39)EG: 42.3±5.6CG:
calcitriol 1751 The other meta-analysis from two trials showed beneficial effects of EXD plus caltrate tablets and calcitriol in improving BMD of femoral neck (MD: 0.04 [0.00, 0.09]; I2=56%; P=0.04), the level of calcium (MD:
calcitriol 2002 and phosphorus (MD: −0.28 [−0.39, −0.17]; I2=68%; P<0.00001) compared with caltrate tablets and calcitriol alone. The adverse drug reactions of EXD were mainly slight gastrointestinal symptoms.ConclusionThe
calcitriol 11063 calcitonin, 3) hormonal treatment, including nilestriol or testosterone propionate, 4) caltrate tablets and calcitriol , 5) caltrate tablets and vitamin D plus alfacalcidol, and 6) elcatonin. The total treatment duration
calcitriol 13057 addition, two studies including 208 participants compared the effect of EXD plus caltrate tablets and calcitriol with caltrate tablets and calcitriol.[28],[29] A pooled analysis indicated that there was no significant
calcitriol 13094 participants compared the effect of EXD plus caltrate tablets and calcitriol with caltrate tablets and calcitriol .[28],[29] A pooled analysis indicated that there was no significant difference between the integrative
calcitriol 14157 formula.[27]–[31] The meta-analysis from two trials demonstrated that EXD plus caltrate tablets and calcitriol was superior to caltrate tablets and calcitriol alone in improving BMD of femoral neck (MD: 0.04 [0.00,
calcitriol 14205 trials demonstrated that EXD plus caltrate tablets and calcitriol was superior to caltrate tablets and calcitriol alone in improving BMD of femoral neck (MD: 0.04 [0.00, 0.09]; I2=56%; P=0.04) (Figure 4).[28],[29]The
calcitriol 16937 were found between the EXD group and caltrate tablets group. However, EXD plus caltrate tablets and calcitriol significantly increased the level of blood Ca (MD: 0.20 [0.15, 0.24]; I2=0%; P<0.00001) and lowered
calcitriol 17156 level of blood P (MD: −0.28 [−0.39, −0.17]; I2=68%; P<0.00001) compared with caltrate tablets and calcitriol based on the meta-analysis. No statistical differences in blood ALP (MD: −1.87 [−7.58, 3.84]; I2=0%;
calcitriol 18633 constipation and 2 cases (2/69, 2.90%) with stomach upset in the modified EXD plus caltrate tablets and calcitriol group.[28] However, the occurrence of ADRs was higher in the caltrate tablets and calcitriol group (P<0.05),
calcitriol 18726 tablets and calcitriol group.[28] However, the occurrence of ADRs was higher in the caltrate tablets and calcitriol group (P<0.05), including 5 cases with abdominal distension (5/69, 7.25%), 7 cases (7/69, 10.14%) with
calcitriol 20519 tablets group in only two studies. The other aggregated result showed that EXD plus caltrate tablets and calcitriol was more effective in increasing BMD of femoral neck and improving the level of blood Ca and P than
calcitriol 20651 increasing BMD of femoral neck and improving the level of blood Ca and P than caltrate tablets and calcitriol in only two studies. Additionally, two independent trials showed that modified EXD or EXD plus elcatonin
calcitriol 23314 factors.ConclusionThe present meta-analysis proved that EXD monotherapy or EXD plus caltrate tablets and calcitriol for osteoporosis may have beneficial effects on the improvement of BMD at anatomical sites. EXD plus
calcitriol 23447 have beneficial effects on the improvement of BMD at anatomical sites. EXD plus caltrate tablets and calcitriol can significantly improve the level of Ca and P. As a result of the methodological drawbacks in the
calcitriol 24245 deviation; df, degrees of freedom.Figure 3Forest plot of comparison between EXD plus caltrate tablets and calcitriol versus caltrate tablets and calcitriol. The outcome was BMD in lumbar spine.Abbreviations: EXD, Erxian
calcitriol 24284 3Forest plot of comparison between EXD plus caltrate tablets and calcitriol versus caltrate tablets and calcitriol . The outcome was BMD in lumbar spine.Abbreviations: EXD, Erxian decoction; BMD, bone mineral density;
calcitriol 24541 deviation; df, degrees of freedom.Figure 4Forest plot of comparison between EXD plus caltrate tablets and calcitriol versus caltrate tablets and calcitriol. The outcome was BMD in femoral neck.Abbreviations: EXD, Erxian
calcitriol 24580 4Forest plot of comparison between EXD plus caltrate tablets and calcitriol versus caltrate tablets and calcitriol . The outcome was BMD in femoral neck.Abbreviations: EXD, Erxian decoction; BMD, bone mineral density;
calcitriol 25975 womenModified EXD (a dose/d, oral administration) + CGCaltrate tablets (600 mg, Qd, oral administration) and calcitriol (0.25 μg, Qd, oral administration)3 monthsBMD (LS, FNCa, P, ALP, ADRJiang et al[29]70 (35/35)EG: 64.64±8.73CG:
calcitriol 26234 womenModified EXD (a dose/d, oral administration) + CGCaltrate tablets (600 mg, Qd, oral administration) and calcitriol (0.25 μg, Bid, oral administration)3 monthsBMD (LS, FNCa, P, ALP, ADRLiu[30]70 (35/35)EG: 42.5±5.1CG:
testosterone 11014 of groups: 1) caltrate tablets, 2) salmon calcitonin, 3) hormonal treatment, including nilestriol or testosterone propionate, 4) caltrate tablets and calcitriol, 5) caltrate tablets and vitamin D plus alfacalcidol,
testosterone 25733 21/18EXD (a dose/d, oral administration)Women: Nilestriol (2~4 mg every 2 weeks, oral administration)Men: testosterone propionate (20~25 mg every 2 weeks, intramuscular)2 monthsBMD (LS, FN, WA, FGTLiu[28]138 (69/69)56.2±9.3Postmenopausal
Select Disease Character Offset Disease Term Instance
osteoporosis 102 Title: Clinical Interventions in AgingEffects of Chinese herbal formula Erxian decoction for treating osteoporosis : a systematic reviewJin-Yu LiYu-Song JiaLi-Min ChaiXiao-Hong MuSheng MaLin XuXu Wei1Department of Orthopaedics,
osteoporosis 669 systematically assess the effectiveness and safety of Chinese herbal formula Erxian decoction (EXD) for treating osteoporosis .Materials and methodsSix databases were searched from inception through September 17, 2016, without
osteoporosis 848 through September 17, 2016, without language restriction. All randomized controlled trials of EXD for osteoporosis were included. One or more outcome measures including fracture, change in bone mineral density (BMD),
osteoporosis 1301 standards.ResultsEight trials including 644 patients investigated the effects of EXD in the treatment of osteoporosis . The methodological quality of the included trials was generally low. The meta-analysis from two trials
osteoporosis 2245 evidence of the superiority of EXD monotherapy or combination therapy over basic supplements for treating osteoporosis . However, the evidence remains weak. More rigorously designed and measured, randomized double-blind,
osteoporosis 2992 in epidemiology studies and in understanding its complex pathogenesis. However, the pathogenesis of osteoporosis is still complex and multifactorial, which makes us put more emphasis on preventing and treating this
osteoporosis 3293 fostered the development of clinical practice guidelines to monitor and provide appropriate choices for osteoporosis intervention.Reducing loss of bone mass, adequately treating clinical symptoms, and preventing osteoporotic
osteoporosis 3470 clinical symptoms, and preventing osteoporotic fractures are the major therapeutic targets. Therefore, osteoporosis management usually includes pharmacological approaches, physiotherapy interventions, health education
osteoporosis 3715 surgical treatment.[6] Among the treatment strategies, the application of drugs in the management of osteoporosis remains a clinical challenge as a result of patient selection, potential adverse effects or patient
osteoporosis 4140 the risk of cardiovascular events.[8],[9] A recent study revealed that 8.5% reported low adherence to osteoporosis medications and 21.6% of patients stopped their medication completely over the 2-year follow-up period.[10]
osteoporosis 4349 period.[10] Therefore, there is a need to seek alternative and effective treatment alternatives for osteoporosis . Clinical practice has shown a bright future for Chinese herbal medicine and Chinese herbal formulas
osteoporosis 4475 practice has shown a bright future for Chinese herbal medicine and Chinese herbal formulas in treating osteoporosis .[11],[12]Erxian decoction (EXD), a traditional Chinese herbal formula, has been widely used for treating
osteoporosis 4624 traditional Chinese herbal formula, has been widely used for treating many chronic diseases, such as osteoporosis , menopausal syndrome, and delayed puberty in the past 60 years.[13],[14] EXD is made up of six herbs,
osteoporosis 5967 appraised evidence such as systematic reviews or meta-analysis to justify the clinical use of EXD for osteoporosis . Thus, the aim of the current systematic review is to investigate the effectiveness and safety of EXD
osteoporosis 6739 searches ended on September 17, 2016. Search terms were Erxian decoction (Er-xian decoction) combined with osteoporosis . The strategy for searching PubMed was listed: ((osteoporosis [MeSH Terms]) AND Erxian decoction) OR
osteoporosis 6801 decoction (Er-xian decoction) combined with osteoporosis. The strategy for searching PubMed was listed: (( osteoporosis [MeSH Terms]) AND Erxian decoction) OR Er-xian decoction.Study selectionRandomized controlled trials
osteoporosis 7025 were included, but crossover randomized trials and quasi-randomized trials were excluded. Diagnosis of osteoporosis was established by bone mineral density (BMD) examination. The following interventions were considered
osteoporosis 7216 interventions were considered for inclusion: EXD versus no treatment or placebo, EXD versus routine anti- osteoporosis medications, EXD plus anti-osteoporosis medications versus anti-osteoporosis medications, EXD plus anti-osteoporosis
osteoporosis 7256 EXD versus no treatment or placebo, EXD versus routine anti-osteoporosis medications, EXD plus anti- osteoporosis medications versus anti-osteoporosis medications, EXD plus anti-osteoporosis medications versus placebo
osteoporosis 7293 EXD versus routine anti-osteoporosis medications, EXD plus anti-osteoporosis medications versus anti- osteoporosis medications, EXD plus anti-osteoporosis medications versus placebo plus anti-osteoporosis medications.
osteoporosis 7333 medications, EXD plus anti-osteoporosis medications versus anti-osteoporosis medications, EXD plus anti- osteoporosis medications versus placebo plus anti-osteoporosis medications. Modified EXD changes based on traditional
osteoporosis 7383 versus anti-osteoporosis medications, EXD plus anti-osteoporosis medications versus placebo plus anti- osteoporosis medications. Modified EXD changes based on traditional Chinese medicine syndrome differentiations were
osteoporosis 10481 1.Study and participant characteristicsEight trials involved a total of 644 patients diagnosed with osteoporosis . The variation in the mean age of participants was 40–70 years. Two trials enrolled middle- and old-aged
osteoporosis 10868 different compositions of EXD or modified EXD were presented in Table 2. The controls were routine anti- osteoporosis medications which had six types of groups: 1) caltrate tablets, 2) salmon calcitonin, 3) hormonal treatment,
osteoporosis 14716 tablets (P=0.009).[30] Xu et al confirmed the effect of combination therapy (modified EXD plus anti- osteoporosis medicine) was better than anti-osteoporosis medicine alone after three months of therapy (P<0.05).[31]Improvement
osteoporosis 14760 the effect of combination therapy (modified EXD plus anti-osteoporosis medicine) was better than anti- osteoporosis medicine alone after three months of therapy (P<0.05).[31]Improvement of BMD in femoral great trochanter.
osteoporosis 16279 elcatonin.[32] After three-month treatment, EXD plus elcatonin could significantly improve the pain symptom of osteoporosis compared with elcatonin alone (P<0.001).Bone biochemical markersThe trials that measured the blood Ca,
osteoporosis 19372 monitored.Publication biasThe funnel plots were not conducted due to the inadequate number of included osteoporosis studies.DiscussionPlant-based therapies including traditional Chinese medicines have long been used
osteoporosis 19506 studies.DiscussionPlant-based therapies including traditional Chinese medicines have long been used to prevent and treat osteoporosis and have received extensive attention.[33]–[35] According to the theory of Chinese medicine, Shen-Jing
osteoporosis 19698 Chinese medicine, Shen-Jing deficiency (Kidney essence) plays an important part in the development of osteoporosis and is better for diagnosing osteoporosis.[36] Therefore, kidney-tonifying herbs or herbal formula contribute
osteoporosis 19740 (Kidney essence) plays an important part in the development of osteoporosis and is better for diagnosing osteoporosis .[36] Therefore, kidney-tonifying herbs or herbal formula contribute to treating both the disease and
osteoporosis 20100 reflecting kidney-tonifying principle.[38] To our knowledge, this is the first systematic review on EXD for osteoporosis with regard to different outcomes.A detailed analysis was performed based on the different interventions,
osteoporosis 20821 showed that modified EXD or EXD plus elcatonin significantly improved pain symptoms in patients with osteoporosis . The ADR of EXD might be abdominal distension, constipation, diarrhea, and stomach upset.In our review,
osteoporosis 21704 need to be considered as a control. Our results indicated that a minimal valid duration of EXD for osteoporosis might be at least 2 months. Nevertheless, the longer duration may achieve better gains. Unlike diabetes
osteoporosis 21862 longer duration may achieve better gains. Unlike diabetes and hypertension, conventional drugs for osteoporosis can bring persistent structural benefits.[40],[41] But so far the long-term effects and safety of EXD
osteoporosis 22201 published in People’s Republic of China, there were no data about the effect of EXD for treating osteoporosis in other countries. Therefore, the potential selection bias could not be ruled out. Second, the majority
osteoporosis 22557 register the study protocol. Similar to the several systematic reviews of alternative medicine for osteoporosis , the methodological quality of RCTs is the major problem affecting the efficacy evaluation.[42],[43]
osteoporosis 23329 factors.ConclusionThe present meta-analysis proved that EXD monotherapy or EXD plus caltrate tablets and calcitriol for osteoporosis may have beneficial effects on the improvement of BMD at anatomical sites. EXD plus caltrate tablets

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