The Effectiveness and Safety of Acupoint Catgut Embedding for the Treatment of Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis

Purpose. To evaluate the effectiveness and safety of acupoint catgut embedding therapy (ACET) in postmenopausal osteoporosis (PMOP). Methods. Review of some databases from their inception to June 2018 and randomized controlled trials (RCTs) in which ACET with PMOP were included. Two researchers extracted and evaluated the information independently. Cochrane Collaboration's tool and Jadad scale were used to evaluate the quality of the studies. RevMan V.5.3.3 software was used to carry out the meta-analysis while trial sequential analysis (TSA) performed with TSA 0.9 software. Results. 12 RCTs with 876 participants were included in this review. Meta-analysis showed that ACET alone was not superior to medication in effectiveness rate (RR = 1.11; 95% CI (0.89, 1.40); P=0.35) and E2 (SMD=0.20; 95% CI (-0.17, 0.57); P=0.28; I-2=20%) while ACET combining medication was more effective on the effectiveness rate (RR=1.32; 95% CI (1.20, 1.46); P<0.000 01) and E2 (SMD= 1.24; 95% CI (0.63, 1.84); P<0.0001). Additionally, ACET combining calcium could increase the bone mineral density (BMD) of the L2 similar to 4 vertebrae and femur-neck [WMDL2 similar to 4 = 0.03; 95% CI (0.01, 0.05); P=0.003; and WMDFemur-neck = 0.07; 95% CI (0.03, 0.10); P = 0.0006], reduce TCM syndrome score [WMD = -1.85; 95% CI (-2.13, -1.57); P<0.000 01], improve patient's quality of life [WMDthree (months) = 6.90; 95% CI (3.90, 9.89); P<0.000 01; and WMDsix (months) = 12.34; 95% CI (5.09, 19.60); P=0.0009], and relieve pain [WMDVAS = -1.26; 95% CI (-1.66, -0.85); P<0.000 01; and WMDPain (score) = -2.59; 95% CI (-4.76, -0.43); P=0.02]. The TSA showed that the effectiveness of ACET for PMOP was demonstrated accurately. Conclusions. ACET combining medication but not ACET alone is more effective than medication as comparison in the treatment of PMOP. As a novel treatment, ACET shows the potential of effectiveness and deserves further high quality of well-designed study.