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Ostéoporose : évaluation de l'acupuncture
| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture. |
| ☆☆ | Evidence for effectiveness of acupuncture. |
| ☆ | Preuves limitées qualitativement et/ou quantitativement en faveur d’une efficacité de l’acupuncture. |
| Ø | No evidence or insufficient evidence. |
1.1. Generic Acupuncture
1.1.1. 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. |
1.1.2. 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. |
1.2. Special Acupuncture Techniques
1.2.1. Aiguilles chauffées
1.2.1.1. Luo 2018
Luo D Jr , Liu Y Jr , Wu Y Jr , Ma R Jr , Wang L Jr , Gu R Jr , Fu W Sr. Warm needle acupuncture in primary osteoporosis management: a systematic review and meta-analysis. Acupuncture in Medicine. 2018;36(4):215-221. [200415].
| Background | Warm needle acupuncture (WNA) is commonly used in primary osteoporosis (OP) management in China. The evidence of its effectiveness needs to be systematically reviewed. |
| Objective | The aim of the meta-analysis was to evaluate whether using WNA alone or combined with conventional medicine benefits primary OP. |
| Methods | PubMed, Embase, the Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang and VIP databases were searched from their inception through 30 June 2016. RCTs applying WNA independently or as an adjunct to conventional medicine, compared with conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle and greater trochanter. The secondary outcome was chronic pain measured by VAS score. Meta-analysis was conducted using RevMan V.5.3 software. |
| Results | Nine RCTs involving 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favour of increasing BMD of the lumbar vertebrae (mean difference (MD)=0.06, 95% CI 0.03 to 0.08, P<0.001). WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, P<0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, P<0.001) when used alone, and additionally decreased VAS scores (MD=-1.10, 95% CI -1.14 to -1.06, P<0.001) when used as an adjunct to conventional medicine. However, the safety of WNA was not specifically reported. |
| Conclusions | WNA may have beneficial effects on BMD and VAS scores of patients with primary OP. However, all included trials were at high risk of bias and of low quality. Further rigorous studies are needed to determine the effectiveness of WNA for primary OP treatment. |
1.2.2. Moxibustion
1.2.2.1. Xu 2017 ∅
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. |
1.2.3. Pharmaco-acupuncture
1.2.3.1. Huang 2019
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. [203749].DOI
| 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. |
1.3.1. Ostéoporose post-ménopausique
2. Revue de revues systématiques
2.1. Xu 2020 ☆☆
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). [205747]. 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. |
