Efficacy of acupuncture-related therapy for postmenopausal osteoporosis: A systematic review and network meta-analysis based on randomized controlled trials

Bing Deng ^1,2 Tiantian Xu ^1,2 Zilan Deng ^1,2 Yue Jiang ^1,2 Li Li ^1,3 Wankun Liang ^1,3 Yuewen Zhang ^1,2 Hongjin Wang ^1,2 Yunxiang Xu ^1,2* Guizhen Chen ^1,3*

• ¹ Guangzhou University of Chinese Medicine, Guangzhou, China
• ² Acupuncture and Rehabilitation Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
• ³ Shenzhen Bao'an Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China

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 2342 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.