Efficacy of acupuncture in the treatment of osteoporosis-related fractures: A systematic review and Bayesian network meta-analysis

In recent years, there has been an increasing interest in the utilization of different acupuncture regimens as alternative therapies for fractures linked to osteoporosis. Nevertheless, the efficacy of these diverse treatment choices continues to be a subject of contention. To tackle this matter, a comprehensive Bayesian network meta-analysis has been undertaken to thoroughly assess the potential advantages of various acupuncture techniques in the management of osteoporosis-related fractures. Until April 12, 2023, an extensive search was carried out to identify randomized controlled trials investigating the application of acupuncture in the treatment of fractures related to osteoporosis. The search encompassed multiple databases, such as PubMed, EMBASE, Web of Science, Cochrane Library, China Knowledge Network (CNKI), WanFang, VIP Database, and SinoMed. The network meta-analysis specifically aimed to evaluate the efficacy of different acupuncture techniques in conjunction with conservative biomedical treatment or invasive biomedical surgical treatment for managing fractures related to osteoporosis. A total of 35 articles were included, involving 2,727 patients. These articles examined and investigated five different types of acupuncture treatment options. The evaluated acupuncture treatments included ordinary acupuncture, electroacupuncture, floating acupuncture, needle-knife, and warm acupuncture. Results showed that when electroacupuncture was combined with daily care, it resulted in a significant decrease in both the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score. Specifically, the VAS score decreased by -2.29 (95% CI: -3.84 ∼ -0.75), while the ODI score decreased by -22.03 (95% CI: -33.88 ∼ -10.54) compared to those who received only daily care. Additionally, there was a significant decrease in the VAS score when comparing the combination of ordinary acupuncture with percutaneous vertebroplasty (PVP) surgery to PVP surgery alone. The VAS score decreased by -1.39 (95% CI: -2.73 ∼ -0.04) in the group that underwent both acupuncture and surgery. Similarly, in the comparison between warm acupuncture combined with percutaneous kyphoplasty (PKP) surgery and PKP surgery alone, there was a significant reduction in the VAS score. The VAS score decreased by -3.62 (95% CI: -5.49 ∼ -1.74) in the group that received both acupuncture and surgery. The implementation of a well-balanced acupuncture treatment regimen can effectively alleviate pain and disability experienced by patients with fractures related to osteoporosis, irrespective of whether surgical intervention is conducted.