Effectiveness and safety of traditional Chinese medicine for bone loss associated with endocrine therapy in patients with breast cancer: a systematic review and meta-analysis

The incidence rate of breast cancer is high, and endocrine therapy for breast cancer frequently causes bone loss.We conducted a systematic review and meta-analysis to review the effect of TCM on bone loss associated with endocrine therapy in patients with breast cancer.Medline (Ovid), EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), VIP full-text Database, Wanfang Database, Chinese Biomedical Literature data (CBM), relevant Chinese and foreign periodicals, conference papers, degree papers, and supplemented by literature tracing were searched.Data from randomized controlled trials (RCTs) on the effects of TCM on bone loss associated with endocrine therapy in patients with breast cancer were collected according to the inclusion and exclusion criteria from the establishment of each database to May 2022.Twenty-two clinical controlled studies were eventually selected.The results of the meta-analysis showed effectiveness (RR (Risk Ratio): 1.22, 95% CI (confidence interval): 1.10-1.36,I 2 = 0%), improvement of lumbar bone mineral density (BMD) (WMD (weighted mean difference): 0.07, 95% CI: 0.06-0.08,I 2 = 23%), improvement of BMD T value (WMD: 0.37, 95% CI: 0.28-0.46,I 2 = 66%), and improvement of BMD in the femoral neck (WMD: 0.07, 95% CI: 0.05-0.09,I 2 = 33%).The funnel chart suggested that a publication bias was observed in the literature, which may be explained by the heterogeneity in the study data and the limited number of included examples.Sensitivity analysis was conducted to confirm that the differences among the studies were acceptable.No study reported adverse effects.Our results indicated that TCM is helpful for bone loss associated with endocrine therapy in patients with breast cancer based on the effectiveness, lumbar BMD, BMD T value, and BMD of the femoral neck.The use of TCM is thus safe.