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Ostéoporose : évaluation de l'acupuncture
1. Acupuncture générique
1.1. Pan 2018
Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P. The Effectiveness of Acupuncture for Osteoporosis: A Systematic Review and Meta-Analysis. Am J Chin Med. 2018;46(3):489-513. [170527].
| Objectives | To summarize the existing evidence and evaluate the efficacy of acupuncture as a clinical treatment for osteoporosis. |
| Methods | Six English and four Chinese databases were searched from their inception to April 2017. Randomized controlled trials were included, in which warm acupuncture, needling or electroacupuncture were compared with sole Western medicine with osteoporosis. All the data were assessed and extracted by two authors independently. The bias risk assessment recommended by the Cochrane Collaboration's tool was used to assess the quality of the selected studies. This meta-analysis was conducted by using RevMan 5.3. Pooled analyses were calculated by standardized mean difference (SMD) and 95% confidence interval (CI). Heterogeneity was assessed by I2 test. |
| Results | Thirty-five studies involving 3014 patients were located. Meta-analysis showed that warm acupuncture could increase the bone mineral density of lumar (SMD [Formula: see text] 0.93, 95% CI [Formula: see text] 0.65, 1.21, [Formula: see text][Formula: see text]0.00001) and femur (MD[Formula: see text][Formula: see text][Formula: see text]0.11, 95% CI[Formula: see text][Formula: see text][Formula: see text]0.05, 0.16, P[Formula: see text][Formula: see text][Formula: see text]0.0002), the level of serum calcium (MD[Formula: see text][Formula: see text][Formula: see text]0.18, 95% CI[Formula: see text][Formula: see text][Formula: see text]0.13, 0.24, [Formula: see text][Formula: see text]0.00001) and estradiol (SMD[Formula: see text][Formula: see text][Formula: see text]0.65, 95% CI[Formula: see text][Formula: see text][Formula: see text]0.32, 0.98, P[Formula: see text][Formula: see text][Formula: see text]0.0001), relieve pain (MD[Formula: see text][Formula: see text][Formula: see text]-1.64, 95% CI[Formula: see text][Formula: see text][Formula: see text]-2.69, -0.59, P[Formula: see text][Formula: see text][Formula: see text]0.002), decrease the level of serum alkaline phosphatase (MD[Formula: see text][Formula: see text][Formula: see text]-7.8, 95% CI[Formula: see text][Formula: see text][Formula: see text]-14.17, -0.84, P [Formula: see text] 0.03) compared with sole Western medicine. Electroacupuncture could relieve pain (MD[Formula: see text][Formula: see text] -1.32, 95% CI[Formula: see text][Formula: see text][Formula: see text]-2.15, -0.48, P[Formula: see text][Formula: see text][Formula: see text]0.002), increase the level of serum calcium (MD[Formula: see text][Formula: see text][Formula: see text]-0.12, 95% CI [Formula: see text] -0.16,-0.09, [Formula: see text][Formula: see text]0.00001) and decrease the level of serum alkaline phosphatase (MD [Formula: see text] -3.63, 95% CI [Formula: see text] -6.60, -0.66, P [Formula: see text] 0.02) compared with sole Western medicine. Needling could relieve pain (MD [Formula: see text] -2.27, 95% CI [Formula: see text] -3.11, -1.43, [Formula: see text][Formula: see text]0.00001) compared with sole Western medicine. |
| Conclusions | This present systematic review indicated that acupuncture could be an effective therapy for treating osteoporosis. Warm acupuncture seemed to more effective than electroacupuncture and needling for osteoporosis in comparison to sole Western medicine. |
1.2. Chen 2018
Chen Jinfeng, Zhang Renwen, Mo Zhuomao, Tang Shujie. [Meta Analysis of Acupuncture Treatment of Primary Osteoporosis]. Journal of Liaoning University of Traditional Chinese Medicine. 2018;(4):. [23442].
| Objective | To evaluate the efficacy and safety of acupuncture in the treatment of primary osteoporosis, in order to provide evidence for clinical reference. |
| Methods | Through a computer comprehensive search randomized controlled trials (RCT) of primary osteoporosis treat with acupuncture and moxibustion in biomedical database what the Pub Med, Chinese Journal Full-text database (CNKI) , Chinese Biomedical literature database (CBM) , VIP Chinese scientific journal database (VIP) , Wang Fang Digital Periodical Full-text Database, the retrieval time interval from inception to November 2016. According to the inclusion and exclusion criteria screening literature, extracted data, using modified Jadad score table to evaluate the quality of the inclusion study and extract the effective data from studies, and using Rev Men 5. 3 software for Mate analysis. |
| Results | A total of 946 patients were included in the RCT involving acupuncture or combination of drugs therapy in the 12 studies, of which 3 high quality, low quality of 9. Mate analysis results showed that acupuncture and moxibustion therapy compared with drugs therapy in the treatment of POP, which was more effective than drug treatment at aspects about improved patients symptoms and clinical efficacy, reduced pain score, improved bone mineral density BMD (L2~4) , Alkaline phosphatase (ALP) levels, which had a significant advantage over than drugs, the difference was statistically significant (P<0. 05) ; to maintain and improve the serum osteocalcin (BGP) considerable side effects, the difference had no statistical significance (P>0. 05). |
| 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. |
2. Techniques particulières
2.1. Xu 2017 (moxibustion)
Xu F, Huang M, Jin Y, Kong Q, Lei Z, Wei X. Moxibustion treatment for primary osteoporosis: A systematic review of randomized controlled trials. PLoS One. 2017. [195282].
| Background | Primary osteoporosis (POP) has a serious impact on quality of life for middle-aged and elderly, which particularly increase the risk of fracture. |
| Methods | We conducted the systematic review to evaluate the effects of moxibustion for POP in randomized controlled trials (RCTs). Eight databases were searched from their inception to July 30, 2016. The RCTs reporting the moxibustion as a monotherapy or in combination with conventional therapy for POP were enrolled. The outcomes might be fracture incidence, quality of life, clinical symptoms, death attributed to osteoporosis, adverse effect, bone mineral density (BMD), and biochemical indicators. Literature selection, data abstraction, quality evaluation, and data analysis were in accordance with Cochrane standards. |
| Results | Thirteen trials including 808 patients were included. Meta-analysis was not conducted because of the obvious clinical or statistical heterogeneity. Limited evidence suggested that moxibustion plus anti-osteoporosis medicine might be more effective in relieving the pain (visual analogue scale scores average changed 2 scores between groups, 4 trials), increasing the BMD of femoral neck (average changed 0.4 g/cm2 between groups, 3 trials), and improving the level of bone gla protein, osteoprotegerin and bone alkaline phosphatase (2 trials) compared with anti-osteoporosis medicine alone. However, the quality of previous studies was evaluated as generally poor. The safety evidence of moxibustion was still insufficient. |
| 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. |
3.1. Ostéoporose post-ménopausique
