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acupuncture:evaluation:rhumatologie - orthopedie:06. osteoporose [22 Sep 2019 07:44] Nguyen Johan |
acupuncture:evaluation:rhumatologie - orthopedie:06. osteoporose [28 Aug 2025 19:12] (Version actuelle) Nguyen Johan [1.1.1. Ma 2025] |
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| + | /*English:Osteporosis*/ | ||
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| + | ======= Osteporosis ======= | ||
| ====== Ostéoporose : évaluation de l'acupuncture ====== | ====== Ostéoporose : évaluation de l'acupuncture ====== | ||
| | //Articles connexes//: - [[acupuncture:conduites therapeutiques:rhumatologie:06. osteoporose|conduites thérapeutiques]] - pathologie - acupuncture expérimentale - qigong - | | | //Articles connexes//: - [[acupuncture:conduites therapeutiques:rhumatologie:06. osteoporose|conduites thérapeutiques]] - pathologie - acupuncture expérimentale - qigong - | | ||
| - | ===== Revues systématiques et méta-analyses ===== | + | ===== Systematic Reviews and Meta-Analysis===== |
| - | |☆☆☆ |Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture. | | ||
| - | |☆☆| Preuves en faveur d’une efficacité de l’acupuncture.| | ||
| - | | ☆ |Preuves limitées qualitativement et/ou quantitativement en faveur d’une efficacité de l’acupuncture.| | ||
| - | |Ø |Absence de preuve ou preuves insuffisantes.| | ||
| - | ==== Acupuncture générique ==== | + | |
| + | ==== Generic Acupuncture ==== | ||
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| + | === Deng 2025 === | ||
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| + | Deng B, Xu T, Deng Z, Jiang Y, Li L, Liang W, Zhang Y, Wang H, Xu Y, Chen G. Efficacy of acupuncture-related therapy for postmenopausal osteoporosis: a systematic review and network meta-analysis based on randomized controlled trials. Front Med (Lausanne). 2025 Apr 9;12:1483819. https://doi.org/10.3389/fmed.2025.1483819 | ||
| + | ^Introduction| To compare and analyze the clinical effects of acupuncture-related therapies for postmenopausal osteoporosis (PMOP) and propose the optimal scheme, we utilized a network meta-analysis to evaluate the therapeutic effects of various commonly used acupuncture methods for PMOP.| | ||
| + | ^Methods| Randomized controlled trials of acupuncture-related therapies for PMOP were searched in eight databases (PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Biomedical Literature Database, and Wanfang database) from January 1, 2002 to December 31, 2023. Our primary outcomes included overall clinical effectiveness rate, bone mineral density (BMD), and visual analog scale scores (VAS). The secondary outcome is adverse events. The entire process of literature screening and data analysis was conducted by 2 independent investigators.| | ||
| + | ^Results| A total of **30 studies with 2,342 participants** provided data suitable for analysis. We compared six interventions: manual acupuncture, electroacupuncture, acupoint catgut embedding, moxibustion, acupoint application, and warm acupuncture. The results of the network meta-analysis revealed that, when compared to conventional Western medication (CWM), multiple acupuncture therapies had a greater impact on the overall clinical effectiveness rate. Electroacupuncture combined with CWM demonstrated superior clinical effectiveness and lumbar spine BMD improvement. Moxibustion with CWM ranked highest for femoral neck BMD, while warm acupuncture showed optimal effects on Ward's triangle and trochanter BMD. Acupoint catgut embedding provided the greatest pain reduction. The most prevalent minor adverse effects included hematoma, discomfort, and scorching.| | ||
| + | ^Conclusion| The results suggest that several acupuncture-related therapies, either alone or in conjunction with CWM, outperform CWM alone and may be regarded as an alternative or supplementary therapy to PMOP, though higher-quality trials are needed.| | ||
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| + | === Ma 2025 === | ||
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| + | Ma T, Zhang T, Zhang L, Zhao H, Liu K, Kuang J, Ou L. Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2025 Jan 31;20(1):127. https://doi.org/10.1186/s13018-025-05513-9 | ||
| + | ^Backgound| Primary osteoporosis (POP) is a common metabolic bone disorder that has a devastating effect on their quality of life in patients. Acupuncture, a traditional Chinese therapy, has been used to treat osteoporosis for over 2000 years. This study aimed to determine the efficacy of acupuncture in treating POP compared to conventional medicine or placebo.| | ||
| + | ^Methods| We searched for potentially relevant studies in PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang database and ClinicalTrials.gov up to December 20, 2024. Randomized controlled trials investigating treatment of POP for which acupuncture was administered as a stand-alone treatment or combined with conventional medicine compared to conventional medicine or placebo, were included. The outcomes included bone mineral density (BMD), visual analogue scale (VAS) scores, clinical effectiveness rate, estradiol (E2), Oswestry Disability Index (ODI), and levels of serum alkaline phosphatase (ALP). Data were synthesized using a random-effects meta-analysis model, and the observed heterogeneity was investigated using subgroup analyses. Study quality was appraised using the Cochrane RoB 2 tools, and the quality of the aggregated evidence was evaluated using the GRADE guidelines. Publication bias was assessed by funnel plots and validated by Egger's test.| | ||
| + | ^Results| **Forty eligible articles with 2654 participants** were identified. Compared to the control group, acupuncture effectively increased the BMD (MD 0.04 [0.03-0.06], P < 0.001, I2 = 92%), clinical efficacy (RR 1.24 [1.14-1.34], P < 0.001, I2 = 81%), and levels of E2 (SMD 0.30 [0.09-0.52], P = 0.006, I2 = 0%), and reduced the VAS scores (SMD - 1.79 [- 2.29 to - 1.29], P < 0.001, I2 = 95%). Data on ODI and ALP were insufficient for meta-analysis.| | ||
| + | ^Conclusion| The current evidence suggests that the efficacy of acupuncture in improving the symptoms of POP are encouraging for its use in clinical practice as a physical intervention for patients with POP. However, since the included patients were all from China, there was a risk of sample bias, high-quality multicenter studies in different countries or regions should be conducted in the future.| | ||
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| + | === Teng 2025 === | ||
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| + | Teng Z, Zhu J, Li K, Tong T, Li W, Chu H, Sun P. Efficacy and safety of acupuncture as an adjuvant therapy for osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2025 May 9;16:1561344. https://doi.org/10.3389/fendo.2025.1561344 | ||
| + | ^Objective| To systematically evaluate the efficacy and safety of acupuncture as an adjuvant therapy for osteoporosis (OP) through a comprehensive synthesis of recent randomized controlled trial (RCT) evidence.| | ||
| + | ^Methods| A systematic literature search was conducted across PubMed, Web of Science, CNKI, and Wanfang databases (2014 - 2024) to identify RCTs investigating acupuncture combined with conventional therapy for OP. Study quality was appraised using the Cochrane Risk of Bias tool, and meta-analyses were performed using RevMan 5.4 and Stata 15.0, with subgroup analyses stratified by intervention type, population characteristics, and treatment duration.| | ||
| + | ^Results| **28 RCTs (n=2,758)** were included. Meta-analysis revealed acupuncture significantly enhanced bone mineral density (BMD) versus controls: total (SMD = 0.47, p = 0.03), femoral neck (MD = 0.05, p = 0.01), lumbar spine (SMD = 0.40, p < 0.001), Ward's triangle (MD = 0.07, p = 0.02), and hip (SMD = 0.55, p < 0.001), with particularly marked improvements in the postmenopausal osteoporosis subgroup. Acupuncture demonstrated significant improvements in treatment efficacy, biochemical markers, pain scores, and symptom assessments, while reducing adverse events. Warm needle moxibustion outperformed controls in femoral neck (MD = 0.07, p = 0.002) and hip BMD (SMD = 0.87, p < 0.001), while electroacupuncture significantly elevated serum calcium (MD = 0.18, p = 0.02). Short-term interventions (≤ 3 months) demonstrated optimal efficacy.| | ||
| + | ^Conclusion| Acupuncture demonstrates efficacy and safety as an OP adjuvant therapy. Current evidence is limited by regional bias and methodological heterogeneity. Multicenter, large-sample RCTs are needed to standardize protocols and validate long-term therapeutic efficacy.| | ||
| === Pan 2018 ☆☆=== | === Pan 2018 ☆☆=== | ||
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| ^Conclusion| **This study showed that acupuncture treatment is safe and effective in improving the clinical symptoms and BMD in the treatment of primary osteoporosis**, but it has little difference in improving BGP. It is worth paying attention to and popularizing the application. Because the quality and quantity of RCT included in this study are limited. Which high quality, large sample, multicenter randomized controlled trial are needed to confirm. | | ^Conclusion| **This study showed that acupuncture treatment is safe and effective in improving the clinical symptoms and BMD in the treatment of primary osteoporosis**, but it has little difference in improving BGP. It is worth paying attention to and popularizing the application. Because the quality and quantity of RCT included in this study are limited. Which high quality, large sample, multicenter randomized controlled trial are needed to confirm. | | ||
| - | ==== Techniques particulières ==== | + | ==== Special Acupuncture Techniques ==== |
| - | === Aiguilles chauffées === | + | === Warm Needle === |
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| === Moxibustion === | === Moxibustion === | ||
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| + | == Li 2022 ☆ == | ||
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| + | Li X, Yin Z, Li X, Yin B, Liu Y, Qi W, Liang F. Efficacy of Moxibustion for Primary Osteoporosis: A Trial Sequential Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2022 Sep 27;2022:1268876. https://doi.org/10.1155/2022/1268876 | ||
| + | ^Background|Primary osteoporosis (PO) is a systemic metabolic skeletal disease. Previous studies have shown that moxibustion can reduce pain intensity and enhance response rate, bone mineral density (BMD), and living function of the patients with PO. However, consensus on its efficacy does not exist, and evidence of moxibustion for PO is also insufficient.| | ||
| + | ^Methods|We searched five English and four Chinese databases with various additional sources and published reviews through December 1, 2021, to evaluate potentially concerned randomized controlled trials (RCTs). Two independent researchers addressed selection screening, data extraction, and risk of bias assessment. The data of this meta-analysis were analyzed using the RevMan v.5.4 software. Additionally, the trial sequential analysis v.0.9.5.10 β was used to estimate the sample size. In contrast, the quality of evidence from the RCTs was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool.| | ||
| + | ^Results| The current meta-analysis included **14 RCTs** containing **898 participants**. The methodological quality of the RCTs was moderate. The review demonstrated that a combination of moxibustion and conventional medicine (CM) significantly reduced pain intensity and improved the BMD compared with CM. Furthermore, it was found that moxibustion plus CM/moxibustion could improve response rates compared with CM. However, it was found that the reduction of pain intensity and improvement of BMD by moxibustion showed no significant difference compared with CM. It was also evident that the sample size of most outcomes was inadequate. Moreover, all evidence obtained in this study was ranked as low to critically low.| | ||
| + | ^Conclusions| In conclusion, it was demonstrated that moxibustion is a potentially effective agent for treating PO. However, high-quality studies should be implemented in the future because this study only obtained low-quality evidence. This study was registered in the PROSPERO platform (CRD42021291310).| | ||
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| ^Conclusions|Due to the paucity of high-quality studies, there was no definite conclusion about the efficacy and safety of moxibustion treating POP although parts of positive results were presented. Future research should pay attention to the dose-response relation and fracture incidence of moxibustion for POP. | | ^Conclusions|Due to the paucity of high-quality studies, there was no definite conclusion about the efficacy and safety of moxibustion treating POP although parts of positive results were presented. Future research should pay attention to the dose-response relation and fracture incidence of moxibustion for POP. | | ||
| - | ==== Formes cliniques particulières ==== | + | === Electroacupuncture === |
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| + | == Fan 2021 == | ||
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| + | Fan L, Wu Z, Li M, Jiang G. Effectiveness of electroacupuncture as a treatment for osteoporosis: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(3):. [216720]. [[https://doi.org/10.1097/md.0000000000024259|doi]] | ||
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| + | ^Background| Osteoporosis (OP) results in an increased risk of fragility fractures, representing a major public health problem. In preventing OP, complementary and alternative medicine, such as acupuncture, was recommended because of the low efficiency and side effects of medications. Recently, there is insufficient evidence on electroacupuncture as an effective therapy for OP management. Hence, we evaluated the effectiveness of electroacupuncture for OP treatment. | | ||
| + | ^ Methods| We conducted a systematic review and meta-analysis of clinical studies on patients with OP. Five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to March 12, 2020. Randomized controlled trials (RCTs) were included if electroacupuncture was applied as the sole treatment or as an adjunct to other treatments compared with medications in patients with OP. The measurement outcomes included serum aminoterminal propeptide of type I procollagen (PINP) and C-telopeptide of type I collagen (CTX) levels, bone mineral density (BMD) of lumbar, and visual analog scale scores for OP-related pain. Acupoints were extracted when available. | | ||
| + | ^Results|In total, **11 RCTs involving 731 participants** were included for further meta-analysis. The meta-analysis showed that the use of electroacupuncture as a sole treatment or as an adjunct to other treatments could relieve OP-related pain compared with medications [mean difference (MD) = -0.58, 95% confidence interval (CI); MD = -0.97 to -0.19, P = .003, I2 = 88%; MD = -1.47, 95% CI = -2.14 to -0.79, P < .001, I2 = 96%). Meanwhile, the results showed a favorable effect of electroacupuncture on decreasing serum beta-CTX levels. However, there were no significant differences in serum PINP levels and BMD of lumbar. Shenshu (BL23) was the most frequent acupoint stimulation among these studies. | | ||
| + | ^Conclusions|The application of electroacupuncture as an independent therapy or as an adjunct to other treatments might attenuate OP-related pain and serum beta-CTX levels. However, to overcome the methodological shortcomings of the existing evidence, due to a small size of samples and high risk of bias in these included RCTs, further rigorous studies are required. | | ||
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| + | === Pharmaco-acupuncture === | ||
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| + | == Huang 2019 == | ||
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| + | Huang R, Li X, Xu S, Li D, Yan P, Liu B, Xie X, Yang K. Acupoint injection treatment for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Ann Palliat Med. 2019;8(5):586-595. {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:huang-203749.pdf|[203749]}}.[[https://doi.org/10.21037/apm.2019.11.23|DOI]] | ||
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| + | ^Background|Acupoint injection has currently received increasing attention as a treatment for primary osteoporosis (POP), This study aimed to evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP. | | ||
| + | ^Methods|Randomized controlled trials (RCTs) of acupoint injection compared with conventional non-acupoint injection for POP were identified in searches of seven databases from their inception to March 2019. All data were assessed and extracted by two authors independently. The risk of bias assessment recommended by the Cochrane Collaboration was used to assess the quality of the selected studies. RevMan 5.3 was used to conduct meta-analysis for the efficacy and safety of acupoint injection. | | ||
| + | ^Results|**Five trials with 337 patients** (aged 45-86 years) with bone mineral density (BMD) ≤2 SD were included in our meta-analysis. The results showed that, compared with conventional intramuscular injection, acupoint injection significantly increased the BMD [mean difference (MD) =0.02; 95% CI, 0.01 to 0.03, P<0.00001]. Subgroup analysis indicated that acupoint injection significantly improved lumbar BMD (MD =0.02; 95% CI, 0.01 to 0.03, P<0.00001) but did not reduce the pain score (SMD =-2.29, 95% CI, -6.81 to 2.23, P>0.05). Individuals results showed that acupoint injection improved biochemical indicators, such as NBAP, IGF-I and reduced CTX and leptin levels. While the risk of bias was high in all five trials.| | ||
| + | ^Conclusions|This meta-analysis and systematic review suggests that acupoint injection improves BMD and some biochemical indicators in POP patients compared with the effects of conventional intramuscular injection. However, due to the high risk of bias in all the trials reviewed, the evidence remains inconclusive and future research will be required with improved methodological quality. | | ||
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| + | ==== Special Clinical Forms ==== | ||
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| + | === Postmenopausal Osteoporosis === | ||
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| + | | See [[acupuncture:evaluation:gyneco-obstetrique:06. osteoporose post-menopausique|Corresponding item]]| | ||
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| + | === Osteoporotic Fracture === | ||
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| + | == Sheng 2024 == | ||
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| + | Sheng R, Wu M, Qiu Y, Sun Q. Efficacy of acupuncture in the treatment of osteoporosis-related fractures: A systematic review and Bayesian network meta-analysis. Eur J Integr Med. 2024 Aug;69:102378. https://doi.org/10.1016/j.eujim.2024.102378 | ||
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| + | ^Introduction| In recent years, there has been an increasing interest in the utilization of different acupuncture regimens as alternative therapies for fractures linked to osteoporosis. Nevertheless, the efficacy of these diverse treatment choices continues to be a subject of contention. To tackle this matter, a comprehensive Bayesian network meta-analysis has been undertaken to thoroughly assess the potential advantages of various acupuncture techniques in the management of osteoporosis-related fractures. | | ||
| + | ^Methods| Until April 12, 2023, an extensive search was carried out to identify randomized controlled trials investigating the application of acupuncture in the treatment of fractures related to osteoporosis. The search encompassed multiple databases, such as PubMed, EMBASE, Web of Science, Cochrane Library, China Knowledge Network (CNKI), WanFang, VIP Database, and SinoMed. The network meta-analysis specifically aimed to evaluate the efficacy of different acupuncture techniques in conjunction with conservative biomedical treatment or invasive biomedical surgical treatment for managing fractures related to osteoporosis. | | ||
| + | ^Results| A total of **35 articles were included, involving 2,727 patients**. These articles examined and investigated five different types of acupuncture treatment options. The evaluated acupuncture treatments included ordinary acupuncture, electroacupuncture, floating acupuncture, needle-knife, and warm acupuncture. Results showed that when electroacupuncture was combined with daily care, it resulted in a significant decrease in both the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score. Specifically, the VAS score decreased by -2.29 (95 % CI: -3.84 ∼ -0.75), while the ODI score decreased by -22.03 (95 % CI: -33.88 ∼ -10.54) compared to those who received only daily care. Additionally, there was a significant decrease in the VAS score when comparing the combination of ordinary acupuncture with percutaneous vertebroplasty (PVP) surgery to PVP surgery alone. The VAS score decreased by -1.39 (95 % CI: -2.73 ∼ -0.04) in the group that underwent both acupuncture and surgery. Similarly, in the comparison between warm acupuncture combined with percutaneous kyphoplasty (PKP) surgery and PKP surgery alone, there was a significant reduction in the VAS score. The VAS score decreased by -3.62 (95 % CI: -5.49 ∼ -1.74) in the group that received both acupuncture and surgery. | | ||
| + | ^Conclusions| The implementation of a well-balanced acupuncture treatment regimen can effectively alleviate pain and disability experienced by patients with fractures related to osteoporosis, irrespective of whether surgical intervention is conducted. | | ||
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| + | == Li 2023 (retracted) == | ||
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| + | <color #ed1c24> Retracted</color>: Meta-Analysis of PKP or PVP Combined with Acupuncture in the Treatment of Osteoporotic Vertebral Compression Fractures. Contrast Media Mol Imaging. 2023 Oct 4;2023:9783081. https://doi.org/10.1155/2023/9783081 | ||
| + | == Li 2021 == | ||
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| + | Li JL, Rong S, Zhou Z, Zhang XB, Tang ZH, Huang QS, Li WH. The Efficacy and Safety of Acupuncture for Treating Osteoporotic Vertebral Compression Fracture- (OVCF-) Induced Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Evid Based Complement Alternat Med. 2021. [222738]. | ||
| + | https://doi.org/10.1155/2021/8574621 | ||
| + | ^ Background| Osteoporotic vertebral compression fractures (OVCFs) are common health issues in the elderly that cause chronic pain in over one-third of patients. This study was sought to evaluate the efficacy and safety of acupuncture for alleviating pain caused by OVCFs. | | ||
| + | ^Methods| We performed a search of 8 electronic databases for publications from the inception to 30th March 2021. Eligible studies were randomized clinical trials (RCTs) that evaluated the effect of acupuncture for the treatment of OVCFs. Two investigators evaluated literature quality and extracted data independently. RevMan V.5.4.1 was used for data analyses, with pooled risk estimates presented as mean difference (MD) or relative risk (RR) along with corresponding 95% confidence intervals (CIs), as appropriate. | | ||
| + | ^Results|Fourteen RCTs involving 1,130 patients were included in this meta-analysis. Compared with the control group, acupuncture showed a greater benefit on pain reduction caused by OVCFs (1 week: MD = -1.26, 95% CI: (-1.82,-0.70); 1 month: MD = -1.63, 95% CI: (-1.82,-1.43); 6 months: MD = -1.13, 95% CI: (-1.55, -0.70)). Acupuncture treatment was also associated with fewer adverse events, lower ODI index, and higher bone density than the control group (safety: (RR: 0.30, 95% CI: 0.12-0.75); ODI: MD = -3.19, 95% CI: (-5.20, -1.19); bone density: MD = 0.15, 95% CI: (0.05, 0.26)). The GRADE quality of these results was assessed as low or very low. | | ||
| + | ^Conclusions| Compared with the control treatment, acupuncture was more effective and safer in relieving the pain caused by OVCF and made a greater improvement on patient's ODI score and bone density. Given the low level of our study evidence, future high-quality studies are needed to verify our study findings.| | ||
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| + | ===== Revue de revues systématiques ===== | ||
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| + | ==== Xu 2020 ☆☆==== | ||
| - | === Ostéoporose post-ménopausique === | + | Xu G, Xiao Q, Zhou J, Wang X, Zheng Q, Cheng Y, Sun M, Li J, Liang F. Acupuncture and moxibustion for primary osteoporosis: An overview of systematic review. Medicine (Baltimore). 2020;99(9). {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:xu-205747.pdf|[205747]}}. [[http://dx.doi.org/10.1097/MD.0000000000019334|doi]] |
| + | ^Background|Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial. | | ||
| + | ^Objective|To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality. | | ||
| + | ^Methods|A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). | | ||
| + | ^Results| According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain. | | ||
| + | ^Conclusions|Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required. | | ||
| - | | Voir l'article : [[acupuncture:evaluation:gyneco-obstetrique:06. osteoporose post-menopausique|Ostéoporose post-ménopausique]]| | ||
