Optimal kidney-tonifying traditional chinese medicines for postmenopausal osteoporosis: A network meta-analysis of randomized controlled trials

Objective: To evaluate the efficacy and safety of different kidney-tonifying Chinese medicines (KTCMs) combined with bisphosphonates (BPs) in postmenopausal osteoporosis (PMOP) patients.<br /> Methods: This study included 15 randomized controlled trials (RCTs) involving a total of 1,360 PMOP patients to compare the efficacy and safety of various KTCMs combined with BPs. A systematic search was conducted in eight medical databases (CNKI, PUBMED, Web of Science, Cochrane, EMBASE, Wan- fang, VIP, and TCM Online). The inclusion criteria were as follows: (1) participants were postmenopausal women with PMOP; (2) the intervention involved different KTCMs combined with BPs; (3) outcome measures included pain Visual Analog Scale (VAS) scores, lumbar spine bone mineral density (BMD), femoral neck BMD, serum osteocalcin levels, and the incidence of adverse events. A network meta-analysis was performed to integrate data, calculating mean differences (MD) with 95 % confidence intervals (CIs). SUCRA values were used to rank treatment efficacy and assess the relative advantages of different regimens. League tables were used to visually present direct and indirect comparisons of treatments, while funnel plots were used to evaluate publication bias. The quality of the included studies was assessed using the Cochrane risk-of-bias tool.<br /> Results: GSK + BPs and JWEX + BPs were the most effective in pain relief, while GSK + BPs showed the best efficacy in improving lumbar spine and femoral neck BMD. LWDH + BPs demonstrated superior performance in promoting bone metabolism. Safety analysis indicated a low incidence of adverse events, with no statistically significant difference between the experimental and control groups (p > 0.05). Conclusion: This study suggests that GSK + BPs and JWEX + BPs are the most effective combinations for pain relief and BMD improvement, while LWDH + BPs and GSK + BPs have advantages in promoting bone metabolism. The combination of KTCMs with BPs can effectively improve PMOP with high safety, offering significant clinical value.