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Chinese herbal medicines for treating osteoporosis

  1. Yunxia Liu1,*,
  2. Jian Ping Liu2,
  3. Yun Xia3

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 6 MAR 2014

Assessed as up-to-date: 9 JAN 2013

DOI: 10.1002/14651858.CD005467.pub2


How to Cite

Liu Y, Liu JP, Xia Y. Chinese herbal medicines for treating osteoporosis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD005467. DOI: 10.1002/14651858.CD005467.pub2.

Author Information

  1. 1

    Shandong University, Department of Epidemiology and Biostatistics, School of Public Health, Jinan, China

  2. 2

    Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine, Beijing, China

  3. 3

    Beijing University of Chinese Medicine Subsidiary Dongfang Hospital, Science of Education, Beijing, China

*Yunxia Liu, Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, 44 Wenhua Xilu Road, Jinan, 250012, China. lyx7677@hotmail.com. yunxialiu@163.com.

Publication History

  1. Publication Status: New
  2. Published Online: 6 MAR 2014

SEARCH

 
Characteristics of included studies [ordered by study ID]
An SJ 2000

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect and mechanism of kidney-tonifying herbs on postmenopausal osteoporosis

Study design: double-blind, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

111 postmenopausal osteoporosis patients enrolled: 31 in Kanggusong granule group, 40 in ipriflavone group, 40 in Caltrate group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels recommended by WHO; BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Kanggusong granule, 12 g, twice daily, for 9 months

Control 1: ipriflavone (200 mg, 3 times a day) and Caltrate (1 tablet per day), for 9 months

Control 2: Caltrate (1 tablet per day), for 9 months


OutcomesBMD, E2, Ca, P, ALP, fractures


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskIt was described as double-blind but did not describe who was blinded

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Cao GY 2010

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect of integrated traditional Chinese and western medicine on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese
57 primary osteoporosis patients enrolled: 30 in trial group, 27 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis based on bone density levels

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Chinese medicine Bushenhuoxue recipe (1 dose per day, water fried) and conventional western medicine (alfacalcidol soft capsules, bisphosphonate and salmon calcitonin, etc.) based on the patient's condition, for 3 months

Control: conventional western medicine based on the patient's condition, for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo detailed description and P value for the baseline comparison not stated

Cao W 2010

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect of integrated traditional Chinese and western medicine on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese
120 postmenopausal osteoporosis patients enrolled: 60 in trial group, 60 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis based on bone density levels

Exclusion criteria: serious women's illnesses, malignant tumour, diabetes, etc.


InterventionsExperimental: Chinese medicine (combinations of herbs) (1 dose per day, water fried 300 ml, twice a day), tamoxifen (20 mg per day) and Caltrate (600 mg, 1 to 2 tablets per day), for 3 months

Control: tamoxifen (20 mg per day) and Caltrate (600 mg, 1 to 2 tablets per day), for 3 months


OutcomesBMD, Ca, ALP, adverse events


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'.

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Chen FS 2001

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to observe the therapeutic effect of integrated traditional Chinese and western medicine on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

64 postmenopausal osteoporosis patients enrolled: 32 in trial group, 32 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Gushen decoction (1 dose per day), Caltrate (600 mg per day) and Alfacalcidol (0.25 μg per day), for 24 weeks

Control: Caltrate (600 mg per day) and Alfacalcidol (0.25 μg per day), for 24 weeks


OutcomesBMD, E2, Ca, P, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Chen JP 1999

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Gukang oral liquid on postmenopausal osteoporosis

Study design: single-blind, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese
61 postmenopausal osteoporosis patients enrolled: 36 in trial group, 25 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by single photon absorptiometry (SPA)

Exclusion criteria: secondary osteoporosis, etc.


InterventionsExperimental: Gukang oral liquid (a basic herbal compound), 10 ml, 3 times a day, for 6 months

Control: Tridin, 1 tablet, 3 times a day, for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind but did not describe who was blinded

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Chen NQ 2006

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Shenyao capsules on primary osteoporosis

Study design: single-blind, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

100 primary osteoporosis patients enrolled: 50 in trial group, 50 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, endocrine disease


InterventionsExperimental: Shenyao capsules (2 capsules, 3 times a day) for 6 months

Control: Caltrate (600 mg, once a day), for 6 months


OutcomesBMD, Ca, P, ALP, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind but did not describe who was blinded

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo detailed description and P value for baseline comparison not stated

Chen X 2008

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect of Gukang decoction on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2test

Loss to follow-up: not reported


ParticipantsEthnicity: China

83 primary osteoporosis patients enrolled: 42 in trial group, 41 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Gukang decoction, 1 dose per day, for 4 months

Control: alendronate sodium tablets, 10 mg, once a day, for 4 months


OutcomesBMD, E2, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskSequence generated by some rule based on clinic time

Allocation concealmentHigh riskAllocation based on clinic time

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Chen XL 2010

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Heche Dazao pill on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

114 primary osteoporosis patients enrolled: 57 in trial group, 57 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: liver or kidney disease, endocrine diseases, etc.


InterventionsExperimental: Heche Dazao pill (1 dose per day, water fried twice, twice a day) and Gaitianli (300 mg, 3 times a day), for 3 months

Control: Gaitianli (300 mg, 3 times a day), for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Chen YQ 2001

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Jiarong tablet on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

61 postmenopausal osteoporosis patients enrolled: 20 in trial group, 20 in Livial group, 21 in Caltrate group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Jiarong tablet (5 g, 3 times a day) and Caltrate (1 tablet per day), for 6 months
Control: Livial (2.5 mg, every other day) and Caltrate (1 tablet per day), or Caltrate (1 tablet per day), for 6 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline comparison

Chen ZX 2002

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect of Gushukang granule on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese
62 postmenopausal osteoporosis patients enrolled: 23 in Gushukang granule and Calcium carbonate with vitamin D chewable tablets group, 20 in Gushukang granule group, 19 in Calcium carbonate with vitamin D chewable tablets group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels recommended by WHO, BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Gushukang granule (10 g, twice a day) and Calcium carbonate with vitamin D chewable tablets (1 tablet, twice a day), or Gushukang granule (10 g, twice a day), for 6 months

Control: Calcium carbonate with vitamin D chewable tablets, 1 tablet, twice a day, for 6 months


OutcomesBMD, Ca, P, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers table

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Cui TH 1999

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect of Strong Bone capsule on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

105 postmenopausal osteoporosis patients enrolled: 74 in trial group, 31 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels recommended by WHO; BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Strong Bone capsule (a basic herbal compound), 5 capsules, 3 times a day, for 3 months

Control: Caltrate, 1 tablet per day, for 3 months


OutcomesBMD, E2, Ca, P, ALP, BGP, CT, adverse effects


NotesThe study was supported by administration of traditional Chinese medicine scientific research funds in Jiangsu Province, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline comparison

Dai Y 2007

MethodsCountry: China

Setting: hospital based

Aim: to observe the therapeutic effect of Migu tablet on BMD, OPG, etc. in patients with postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: analysis of variance (F-test)

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

160 postmenopausal osteoporosis patients enrolled: 54 in Migu tablet trial group, 53 in Xianlinggubao group, 53 in compound calcium amino acid chelate capsules group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism, endocrine diseases, etc


InterventionsExperimental: Migu tablet group: Migu tablet, 1 tablet, 3 times a day and compound calcium amino acid chelate capsule, 1 g, once a day; for 24 weeks

Xianlinggubao group: Xianlinggubao capsule, 0.5, g 3 times a day and compound calcium amino acid chelate capsule, 1 g, once a day, for 24 weeks

Control: compound calcium amino acid chelate capsule, 1 g, once a day, for 24 weeks


OutcomesBMD


NotesThe study was supported by a health department funded project in Hubei Province, but no declarations of interest for the primary researchers was reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline comparison

Deng WM 2012

MethodsCountry: China

Setting: hospital based

Aim: to observe the kidney-tonifying herbal Fufangs with phytoestrogenic Epimedium for prevention of postmenopausal osteoporosis with both BMD and fracture as study endpoints

Study design: a multicentre, double-blind, randomised controlled trial

Analysis: F-test, Chi2 test based on the intention-to-treat (ITT) principle

Loss to follow-up: 5-year follow-up. At the end of 5 years, 155 participants had completed the study (13 drop-outs in the treatment group, 26 drop-outs in the control group); the difference in drop-out rate was statistically significant between the 2 groups (P < 0.05)


ParticipantsEthnicity: Chinese

194 postmenopausal osteoporosis patients enrolled: 101 in experimental group, 93 in placebo group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: those who used any kind of anti-osteoporosis drugs or had been under HRT during the past year; current medical disease(s) associated with potential development of metabolic bone diseases, including Paget disease, osteomalacia, bone marrow disease, hereditary disorders of calcium or mineral metabolism, adrenal disorders, poorly controlled diabetes mellitus, severe connective tissue disorders, gastrointestinal diseases and current or past history of clinically significant haematological, endocrinological, cardiovascular, renal, hepatic, gastrointestinal, psychiatric or neurological diseases


InterventionsExperimental: Bushen Zhuanggu granules (10 g per day, twice per day), plus calcium (600 mg) and vitamin D (400 IU)

Control: placebo granules (10 g per day, twice per day), plus calcium (600 mg) and vitamin D (400 IU)


OutcomesBMD, fracture, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline comparison

Dong Y 2010

MethodsCountry: China

Setting: outpatients

Aim: to evaluate the efficacy and safety of salmon calcitonin plus Xianlinggubao for osteoporosis and ostealgia in postmenopausal women

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

160 postmenopausal osteoporosis patients enrolled: 54 in Xianlinggubao plus salmon calcitonin group, 53 in Xianlinggubao group, 53 in salmon calcitonin control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism, endocrine diseases, secondary osteoporosis, liver or kidney disease, etc.


InterventionsExperimental: Xianlinggubao plus salmon calcitonin group: Xianlinggubao (1.5 g, twice a day), salmon calcitonin (500 IU, once a day) and Caltrate (1 tablet per day), for 3 months

Xianlinggubao group: Xianlinggubao (1.5 g, twice a day) and Caltrate (1 tablet per day), for 3 months

Control: salmon calcitonin (500 IU, once a day) and Caltrate (1 tablet per day), for 3 months


OutcomesBMD, ALP, BGP, Ca, P, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Dong YF 2004

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of traditional Chinese herbs on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 senile osteoporosis patients enrolled: 40 in trial group, 40 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine diseases, secondary osteoporosis, etc.


InterventionsExperimental: traditional Chinese herbs (Longspur Epimedium, etc.), 1 dose per day, for 6 months

Control: vitamin D (10000 U, once a day), Caltrate (600 mg, once a day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Fan HX 2004

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Gengnian Anyi tablet on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 22 in herb trial group, 18 in nilestriol control group, 20 in Caltrate group

Inclusion criteria: international diagnostic criteria for osteoporosis, BMD detected by SPA

Exclusion criteria: endocrine diseases, etc.


InterventionsExperimental: Gengnian Anyi tablet (6 tablets, 3 times a day) and Caltrate (1 tablet per day), for 6 months

Control: nilestriol (2 mg, once a half month) and Caltrate (1 tablet per day), or Caltrate (1 tablet per day), for 6 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline comparison

Gang PH 2001

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Gumiling granule on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

25 primary osteoporosis patients enrolled: 15 in herb trial group, 10 in control group

Inclusion criteria: BMD, detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease, etc.


InterventionsExperimental: Gumiling granule (10 g, 3 times a day), for 6 months

Control: bicarbonate calcium chewable(1 g, twice a day), for 6 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline comparison

Gong L 2001

MethodsCountry: China

Setting: outpatients

Aim: to observe the therapeutic effect of Yishen Zhuanggu mixture on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, F-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 primary osteoporosis patients enrolled: 46 in herb trial group, 17 in herb control group, 17 in blank control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc.


InterventionsExperimental: Yishen Zhuanggu mixture (25 ml, twice a day) in herb trial group, Shengu capsule (2 capsules, 3 times a day) in herb control group, for 6 months

Control: blank


OutcomesBMD, BGP, adverse effects


NotesThe study was supported by a Science and Technology Commission funded project in Beijing, but no declarations of interest of the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Guo JH 2008

MethodsCountry: China

Setting: outpatients

Aim: to explore the effect of Bushen Kangsong pill on BMD in postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

84 postmenopausal osteoporosis patients enrolled: 42 in trial group, 42 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism, liver or kidney disease, etc.


InterventionsExperimental: Bushen Kangsong pill, 3 g, 3 times a day, calcium carbonate, 4 tablets, 3 times a day, for 6 months

Control: calcium carbonate, 4 tablets, 3 times a day, for 6 months


OutcomesBMD


NotesThe study was supported by the Science Foundation for Post-doctoral Scientists of Jiangsu Province, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Han XL 2007

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to explore the effect of Shugan Zishen Huoxue tang on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

42 postmenopausal osteoporosis patients enrolled: 25 in herb trial group, 17 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc.


InterventionsExperimental: Shugan Zishen Huoxue tang (100 ml, twice a day), Caltrate (1.2 g, twice a day) and alendronate sodium (10 mg, once a day), for 6 months

Control: Caltrate (1.2 g, twice a day) and alendronate sodium tablets (10 mg, once a day), for 6 months


OutcomesBMD, E2


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

He MT 2007

MethodsCountry: China

Setting: outpatients

Aim: to explore the effect of Bushen Jianpi Huoxue recipe on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

160 postmenoporosis patients enrolled: 80 in herb trial group, 80 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases, fractures, metabolic disease, etc.


InterventionsExperimental: Bushen Jianpi Huoxue recipe (1 dose per day), for 6 months

Control: alendronate sodium tablets (70 mg per week), for 6 months


OutcomesBMD, IL-6, BGP, ALP, E2


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

He N 2006

MethodsCountry: China

Setting: hospital based

Aim: to explore the effect of Jiawei Zhuangyao Jianshen tang on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

58 postmenopausal osteoporosis patients enrolled: 29 in trial group, 29 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Jiawei Zhuangyao Jianshen tang (1 dose per day) for 3 months

Control: compound calcium amino acid chelate capsules (1 g, once a day), for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

He XQ 2006

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to explore the effect of Bushen Yangxue tang on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 32 in trial group, 28 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine disease, liver or kidney disease


InterventionsExperimental: Bushen Yangxue tang (1 dose per day) and Caltrate (once a day), for 6 months

Control: Caltrate (once a day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Hu J 2012

MethodsCountry: China

Setting: inpatients

Aim: to explore the effect of Shangke Yishen Zhuanggu pill on primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, F-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

300 primary osteoporosis patients enrolled: 155 in trial group, 145 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis

Exclusion criteria: not mentioned


InterventionsExperimental: Shangke Yishen Zhuanggu pill (6 g, 3 times a day), Caltrate (1.2 g, twice a day), and miacalcic ampoule (50 U, 3 times a day, intramuscular injection), for 3 months

Control: Caltrate (1.2 g, twice a day), and miacalcic ampoule (50 U, 3 times a day, intramuscular injection), for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Huang JW 2008

MethodsCountry: China

Setting: hospital based

Aim: to explore the effect of Erxian Yanggu decoction on postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

67 postmenopausal osteoporosis patients enrolled: 34 in trial group, 33 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases, secondary osteoporosis, patients with uterine/breast disease


InterventionsExperimental: Erxian Yanggu decoction, 1 dose per day, alendronate sodium tablets, 70 mg per week, for 6 months

Control: alendronate sodium tablets, 70 mg per week, for 6 months


OutcomesIL-6


NotesThe study was supported by administration of traditional Chinese medicine scientific research funds in Zhejiang Province, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Huang ZJ 2008

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Zishen Gukang pill in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA, DPA, SPA, etc.

Exclusion criteria: disease-affected bone metabolism, etc.


InterventionsExperimental: Zishen Gukang pill (6 g, 3 times a day)

Control: Caltrate (2 pills, once a day), for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskSequence generated by some rule based on clinic time

Allocation concealmentHigh riskAllocation based on clinic time

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Jian QQ 2010

MethodsCountry: China

Setting: inpatients

Aim: to study the effects of Shengsuiyin recipe in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

144 postmenopausal osteoporosis patients enrolled: 73 in trial group, 71 in control group

Inclusion criteria: diagnostic criteria for osteoporosis on Obstetrics and Gynecology in Chinese Medicine

Exclusion criteria: not mentioned


InterventionsExperimental: Shengsuiyin recipe (1 dose per day, water fried) and Caltrate (750 mg, once a day), for 12 months

Control: Caltrate, 750 mg, once a day, for 12 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Lan ZX 2006

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Guli powder in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 primary osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism


InterventionsExperimental: Guli powder (10 g, 3 times a day), for 3 months

Control: Caltrate (once a day), for 3 months


OutcomesBMD, Ca, P, ALP


NotesThe study was supported by administration of traditional Chinese medicine scientific research funds in Sichuan Province, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Li BL 2007

MethodsCountry: China

Setting: hospital based

Aim: to observe the mechanism of Jianshen decoction in treating patients with postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine diseases, disease-affected bone metabolism


InterventionsExperimental: Jianshen decoction, 1 dose per day, for 6 months

Control: alendronate sodium tablets, 10 mg, once a day, for 6 months


OutcomesBMD, ALP, BGP, E2, IL-6


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Li HW 2004

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Ziyin Bushen Zhuanggu prescription in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

45 postmenopausal osteoporosis patients enrolled: 25 in trial group, 20 in control group

Inclusion criteria: international diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc


InterventionsExperimental: Ziyin Bushen Zhuanggu prescription (1 dose per day), Caltrate (1.2 g, twice a day) and miacalcin (50 IU, injection, twice per week), for 8 months

Control: Caltrate (1.2 g, twice a day) and miacalcin (50 IU, injection, twice a week), for 8 months


OutcomesBMD, E2


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Li SL 2004

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Zhuanggu capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc


InterventionsExperimental: Zhuanggu capsule (4 capsules, 3 times a day) and Caltrate (600 mg, once a day), for 6 months

Control: Caltrate (600 mg, once a day), for 6 months


OutcomesBMD, E2, Ca, P, ALP, BGP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Li YH 2008

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Jingujian granule in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 senile osteoporosis patients enrolled: 80 in trial group, 40 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels recommended by WHO

Exclusion criteria: secondary osteoporosis, liver or kidney disease


InterventionsExperimental: Jingujian granule, 8 g, twice a day, for 3 months

Control: Caltrate, 600 mg, once a day, for 3 months


OutcomesBMD, ALP, BGP, adverse effects


NotesThe study was supported by a China academy of traditional Chinese medicine advantage diseases research project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Li YH 2010

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Jingujian granule 1, 2 or 3 in the treatment of primary osteoporosis based on epigastralgia traditional Chinese medicine

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: 30 drop-outs (11 in trial group, 19 in control group) were not included in the analysis


ParticipantsEthnicity: Chinese

210 primary osteoporosis patients enrolled: 140 in trial group (11 drop-outs), 70 in control group (19 drop-outs)

Inclusion criteria: Chinese diagnostic criteria for osteoporosis and guiding principles for clinical research on new drugs in traditional Chinese medicine, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease, etc.


InterventionsExperimental: Jingujian granule 1, 2 or 3 based on epigastralgia traditional Chinese medicine (kidney deficiency; spleen and kidney deficiency; spleen and kidney deficiency, and blood stasis), 8 g, twice a day, for 3 months

Control: Caltrate, 600 mg, once a day, for 3 months


OutcomesBMD, ALP, E2, CT, BGP, adverse events


NotesThe study was supported by a China academy of traditional Chinese medicine advantage diseases research project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Li ZP 2011

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Kanggusong soup in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

75 postmenopausal osteoporosis patients enrolled: 45 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: secondary osteoporosis, endocrine disease, liver or kidney disease, etc.


InterventionsExperimental: Kanggusong soup (1 dose per day, twice a day) and Caltrate (1 tablet per night), for 3 months

Control: Caltrate (1 tablet per night), for 3 months


OutcomesALP, IL-6, fractures


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Li ZY 2006

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Xianling Gusong capsules in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

43 postmenopausal osteoporosis patients enrolled: 21 in trial group, 22 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease


InterventionsExperimental: Xianling Gusong capsules (4 capsules, 3 times a day), for 6 months

Control: Caltrate (1 pill, twice a day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Liang DB 2012

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Bushenhuoxue therapy in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 primary osteoporosis patients enrolled: 40 in trial group, 40 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: secondary osteoporosis, liver or kidney disease, etc.


InterventionsExperimental: Bushenhuoxue therapy (1 dose, per day), calcium carbonate tablets (1 tablet (0.5 g), twice a day), and alfacalcidol (1 tablet (0.5 μg) per day), for 3 months

Control: calcium carbonate tablets (1 tablet (0.5 g), twice a day), and alfacalcidol (1 tablet (0.5 μg) per day), for 3 months


OutcomesBMD, quality of life, adverse events


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskNo information provided

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Liao L 2004

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Bushen Shengsui principle in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

100 postmenopausal osteoporosis patients enrolled: 32 in herb trial group, 39 in control group, 29 in blank group
Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc.


InterventionsExperimental: Bushen Shengsui principle, 1 dose per day, for 6 months

Control: Premarin (1 tablet per day) and medroxyprogesterone (2.5 mg per day), or blank, for 6 months


OutcomesBMD, E2, adverse effects


NotesThe study was supported by a science and technology planning project Zhongshan, Guangdong Province, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Lin W 2000

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Migu decoction in the treatment of postmenopausal osteoporosis

Study design: double-blind, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

20 postmenopausal osteoporosis patients enrolled: 13 in trial group, 7 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases


InterventionsExperimental: Migu decoction, for 4 months

Control: placebo, for 4 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Ling JY 2008

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Bushen Zhuanggu decoction in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 primary osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine diseases, liver or kidney disease, etc


InterventionsExperimental: Bushen Zhuanggu decoction, 1 dose per day, for 3 months

Control: alendronate sodium tablets, 10 mg, once a day, for 3 months


OutcomesBMD, E2, ALP, P


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Liu JM 2012

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Gukang tablet in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 primary osteoporosis patients enrolled: 40 in trial group, 40 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: endocrine diseases, liver or kidney disease, etc.


InterventionsExperimental: Gukang tablet (0.5 g per tablet, 6, 3 times a day), Gaitianli tablets (50 mg per tablet, 2 tablets, 3 times a day) and vitamin A and D capsules (1 pill, twice a day), for 3 months

Control: Gaitianli tablets (50 mg per tablet, 2 tablets, 3 times a day), and vitamin A and D capsules (1 pill, twice a day), for 3 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Lv ZH 2002

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Jiawei Bushen Zhuangjintang in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

90 primary osteoporosis patients enrolled: 48 in trial group, 42 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Jiawei Bushen Zhuangjintang, 1 dose per day, for 3 months

Control: calcium granule, 5 g, 3 times a day, for 3 months


OutcomesBMD


NotesThe study was supported by administration of traditional Chinese medicine scientific research funds in Guangdong Province, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Ma C 2011

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Liuwei Dihuang pills in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: F-test, Chi2 test

Loss to follow-up: 1 drop-out in Liuwei Dihuang pills group was not included in the analysis


ParticipantsEthnicity: Chinese

108 postmenopausal osteoporosis patients enrolled: 36 in Liuwei Dihuang pills group, 36 in Caltrate group, 36 in Liuwei Dihuang pills plus Caltrate group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc.


InterventionsLiuwei Dihuang pills group: Liuwei Dihuang pills, 8 pills, 3 times a day, for 6 months

Caltrate group: Caltrate, 1 tablet, 3 times a day, for 6 months

Liuwei Dihuang pills plus Caltrate group: Liuwei Dihuang pills (8 pills, 3 times a day) and Caltrate (1 tablet, 3 times a day), for 6 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Ma CZ 2011

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Yiyuanjiangu decoction in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 primary osteoporosis patients enrolled: 60 in trial group, 60 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: endocrine diseases, liver or kidney disease, etc.


InterventionsExperimental: Yiyuanjiangu decoction (1 dose per day), Miacalcin ampoule (50 U, once a day, intramuscular), and calcium carbonate tablet (1 tablet (0.75 g), twice a day), for 3 months

Control: Miacalcin ampoule (50 U, once a day, intramuscular) and calcium carbonate tablet (1 tablet (0.75 g), twice a day), for 3 months


OutcomesBMD, ALP, Ca, P


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Ma YJ 2011

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Yishen Zhuanggu decoction in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

100 senile osteoporosis enrolled: 50 in trial group, 50 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: secondary osteoporosis, endocrine diseases, liver or kidney disease, etc.


InterventionsExperimental: Yishen Zhuanggu decoction (1 dose per day) and calcitriol soft capsule (0.25 mg, twice a day), for 3 months

Control: calcitriol soft capsule (0.25 mg, twice a day), for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Mao YF 2011

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Bushen Jianpi Jingu decoction in the treatment of postmenopausal osteoporosis

Study design: single-blind, randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

75 postmenopausal osteoporosis patients enrolled: 39 in trial group, 36 in control group

Inclusion criteria: diagnostic criteria for osteoporosis recommend by WHO, BMD detected by DXA

Exclusion criteria: liver or kidney disease, disease-affected bone metabolism, etc.


InterventionsExperimental: Bushen Jianpi Jingu decoction, 1 dose per day, for 3 months

Control:  Miacalcin ampoule (50 U), for 3 months


OutcomesBGP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskSingle-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Unclear riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Meng XD 2003

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Gujian capsule in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

68 primary osteoporosis patients enrolled: 35 in trial group (1 drop-out), 33 in control group (2 drop-out)

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease, etc.


InterventionsExperimental: Gujian capsule (2 capsules, 3 times a day), for 6 months

Control: alfacalcidol (0.5 μg, twice a day), for 6 months


OutcomesBMD, PTH, CT, E2, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Miu JQ 2008

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of a traditional Chinese medicine capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

90 postmenopausal osteoporosis patients enrolled: 60 in trial group, 30 in control group

Inclusion criteria: diagnostic criteria for osteoporosis recommend by WHO, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease


InterventionsExperimental: traditional Chinese medicine capsule (300 mg per pill, 5 pills per day), calcium gluconate, 2 g, 3 times a day, for 9 months

Control: calcium gluconate, 2 g, 3 times a day, for 9 months


OutcomesBGP, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Mu G 2001

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Bushen Qiangshen pill in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

40 postmenopausal osteoporosis patients enrolled: 20 in trial group, 20 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by CUBA ultrasound absorptiometry

Exclusion criteria: endocrine diseases, secondary osteoporosis


InterventionsExperimental: Bushen Qiangshen pill (1 pill, twice a day) and Caltrate (1 tablet, twice a day), for 12 weeks

Control: Caltrate, 1 tablet, twice a day, for 12 weeks


OutcomesE2, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Mu G 2001a

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Bushen Qiangshen pill in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

30 postmenopausal osteoporosis patients enrolled: 15 in trial group, 15 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by CUBA ultrasound absorptiometry

Exclusion criteria: endocrine diseases, secondary osteoporosis


InterventionsExperimental: Bushen Qiangshen pill, 1 pill, twice a day, for 12 weeks

Control: Caltrate, 1 tablet, twice a day, for 12 weeks


OutcomesE2, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Ou L 2011

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Radix rehmanniae preparata, Radix astragali, etc. in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

64 postmenopausal osteoporosis patients enrolled: 32 in trial group, 32 in control group

Inclusion criteria: Chinese and WHO diagnostic criteria for osteoporosis

Exclusion criteria: not mentioned


InterventionsExperimental: Radix rehmanniae preparata, Radix astragali, etc. (1 dose per day), for 6 months

Control:calcium carbonate tablets (600 mg per day, once a day), for 6 months


OutcomesBMD, E2, ALP, Ca, P, PTH, CT


NotesThe study was supported by Shanxi Provincial Department of Education project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Peng T 2002

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Qianggu soft extract in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

118 postmenopausal osteoporosis patients enrolled: 78 in trial group, 21 in calcium gluconate oral group, 19 in blank control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases


InterventionsExperimental: Qianggu soft extract, 20 ml, 3 times a day, for 6 months

Control: calcium gluconate (500 mg, 3 times a day), or blank, for 6 months


OutcomesBMD, E2, Ca, ALP, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Qi ZX 1998

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Bushen Qianggutang in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

40 primary osteoporosis patients enrolled: 20 in trial group, 20 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Bushen Qianggutang, 1 dose per day, fried, for 3 months

Control: Caltrate, 600 mg, twice a day, for 3 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Qiu RB 2004

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Yanghuo Sanzi tang in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Yanghuo Sanzi tang, 150 ml, twice a day, for 6 months

Control: Caltrate, 2 tablets per day, for 6 months


OutcomesBMD, E2, BGP, IL-6


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Qiu RB 2008

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Jiangu prescription in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 postmenopausal osteoporosis enrolled: 60 in trial group, 60 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine disease, liver or kidney disease, disease-affected bone metabolism, etc.


InterventionsExperimental: Jiangu prescription, 1 dose per day, for 6 months

Control: alendronate sodium tablets, 10 mg, once a day, for 6 months


OutcomesBMD, BGP, E2, IL-6


NotesThe study was supported by a Shenzhen science and technology planning project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Qiu ZX 2010

MethodsCountry: China

Setting: inpatients

Aim: to study the effects of Xianlinggubao capsule in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

136 senile osteoporosis patients enrolled: 67 in trial group, 69 in control group

Inclusion criteria: BMD

Exclusion criteria: other diseases


InterventionsExperimental: Xianlinggubao capsule (1 g, 3 times a day) and Caltrate (1 tablet, twice a day), for 12 months

Control: Caltrate, 1 tablet, twice a day, for 12 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo detailed description of diagnostic standard and P value for the baseline comparison not stated

Ruan XY 2006

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Qianggu capsules in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

150 postmenopausal osteoporosis or osteopenia patients enrolled: 50 in herbal trial and hormone group, 50 in herbal group, 50 in hormone group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine disease, digestion disease, mental disorder, etc.


InterventionsExperimental: Qianggu capsules (1 capsule, 3 times a day) and oestradiol valerate (0.5 to 1.5 mg, once a day), for 24 weeks; Qianggu capsules (1 capsule, 3 times a day), for 24 weeks

Control: oestradiol valerate (0.5 to 1.5 mg, once a day), for 24 weeks


OutcomesBMD, adverse effects


NotesThe study was supported by Beijing administration of traditional Chinese medicine scientific research funds and Capital Foundation of Medical Developments Project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Shao M 2003

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Gukang oral liquid in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, etc.


InterventionsExperimental: Gukang oral liquid, 10 ml, 3 times a day, for 6 months

Control: alendronate, 1 tablet per day, for 6 months


OutcomesBMD, E2, ALP, BGP, IL-6


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Shi CD 2012

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Kangshu Jiangu granule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

76 postmenopausal osteoporosis patients enrolled: 40 in trial group, 36 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: liver or kidney disease, endocrine disease, etc.


InterventionsExperimental: Kangshu Jiangu granule, 4 g, 3 times a day, for 6 months

Control: Caltrate, 1 tablet, once a day, for 6 months


OutcomesBMD


NotesThe study was supported by Shanxi Provincial Department of traditional Chinese medicine (TCM) modernisation research plan, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Song XW 2000

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of kidney-tonifying herbs in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

68 postmenopausal osteoporosis patients enrolled: 23 in herb group, 23 in nilestriol group, 22 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: kidney-tonifying herbs, twice a day, for 6 months

Control: nilestriol, 0.2 mg, twice per month; or calcium, 400 mg/d, for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Tang ZA 2012

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Bushen Qianggu Huoxue therapy in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

82 postmenopausal osteoporosis patients enrolled: 42 in trial group, 40 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis

Exclusion criteria: liver or kidney disease, endocrine disease, metabolic disease, etc.


InterventionsExperimental: Bushen Qianggu Huoxue therapy (1 dose per day), calcium (1000 mg per day) and cod liver oil (1 pill per day), for 3 months

Control: calcium (1000 mg per day) and cod liver oil (1 pill per day), for 3 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wang CC 2005

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Gumikang capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 postmenopausal osteoporosis patients enrolled: 32 in trial group, 28 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: metabolic disease, endocrine disease


InterventionsExperimental: Gumikang capsule, 5 capsules, twice a day, for 6 months

Control: calcium gluconate, 500 mg, 3 times a day, for 6 months


OutcomesBMD, E2, Ca, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wang H 2007

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Qianggu paste II in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

123 senile osteoporosis patients enrolled: 75 in trial group, 48 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism


InterventionsExperimental: Qianggu paste II (3.0 g, 3 times a day, for 6 months)

Control: calcium gluconate (500 mg, 3 times a day, for 6 months)


OutcomesBMD, E2, ALP, Ca, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wang J 2007

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Qianggu capsule in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

54 postmenopausal osteoporosis patients enrolled: 28 in trial group, 26 in control group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism


InterventionsExperimental: Qianggu capsule, 0.25 g, 3 times a day, for 6 months

Control: alfa calcidiol capsule, 0.5 μg, twice a day, for 6 months


OutcomesBMD, Ca, P, ALP, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wang JM 2008

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Gukang oral liquid in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

70 postmenopausal osteoporosis patients enrolled: 32 in trial group, 34 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism, secondary osteoporosis


InterventionsExperimental: Gukang oral liquid,10 ml, 3 times a day, for 6 months

Control: alendronate sodium tablets, 10 mg, once a day, for 6 months


OutcomesALP, Ca, E2


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Wang SW 2003

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Antai capsule in the treatment of postmenopausal osteoporosis

Study design: double-blind, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

168 postmenopausal osteoporosis patients enrolled: 65 in herbal group, 60 in ipriflavone group, 63 in Caltrate group Inclusion criteria: WHO diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine disease


InterventionsExperimental: Antai capsule (3 capsules, 3 times a day) and Caltrate (1 tablet per day), for 6 months

Control: ipriflavone (200 mg, 3 times a day) and Caltrate (1 tablet per day), or Caltrate (1 tablet per day), for 6 months


OutcomesBMD, E2, Ca, P, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Wang XD 2011

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Hugu capsule in the treatment of postmenopausal osteoporosis

Study design: double-blind, placebo-controlled, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

122 postmenopausal osteoporosis patients enrolled: 61 in trial group, 61 in control group
Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: bone metabolic disease, endocrine disease, etc.


InterventionsExperimental: Hugu capsule (4 capsules, 3 times a day) and Caltrate (1 tablet per day), for 6 months

Control: placebo capsule (4 capsules, 3 times a day) and Caltrate (1 tablet per day), for 6 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskPatients were randomly allocated

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Wang XY 2000

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Bushen Yigu soft extract in the treatment of osteoporosis

Study design: single-blind, placebo-controlled, randomised controlled trial

Analysis: F-test, T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

96 osteoporosis patients enrolled: 37 in herbal group, 37 in Alfacalcidol group, 22 in placebo group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by SPA

Exclusion criteria: endocrine disease


InterventionsExperimental: Bushen Yigu soft extract, 20 ml, twice a day, for 3 months

Control: Alfacalcidol, 0.25 mg per day, or placebo, for 3 months


OutcomesBMD, E2


NotesThe study was supported by a national department of traditional Chinese medicine (TCM) modernisation research project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wang YZ 2008

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Jiangu capsule in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

125 primary osteoporosis patients enrolled: 63 in trial group, 62 in control group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, metabolic disease, etc.


InterventionsExperimental: Jiangu capsule, 9 g, 3 times a day, for 12 months

Control: Caltrate, 1 tablet per day, for 12 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Wang ZK 2004

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Bushen Jianpi Migu prescription in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

150 senile osteoporosis patients enrolled: 83 in trial group, 67 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine disease, secondary osteoporosis


InterventionsExperimental: Bushen Jianpi Migu prescription, 1 dose per day, for 3 months

Control: Caltrate, 1 tablet, twice a day, for 3 months


OutcomesBMD, Ca, P, ALP, BMC


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskDrawing of lots

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Wei RY 2011

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Kanggusong capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 postmenopausal osteoporosis patients enrolled: 48 in trial group, 32 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, the Chinese diagnostic criteria for primary osteoporosis

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Kanggusong capsule, 3, 3 times a day, for 6 months

Control: Caltrate, 1 tablet each night, for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wu JZ 2010

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Erxian soup in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: F-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

58 primary osteoporosis patients with deficiency of liver and kidney enrolled: 30 in trial group, 28 in control group

Inclusion criteria: the Chinese diagnostic criteria for primary osteoporosis and guiding principles for clinical research on new drugs in traditional Chinese medicine

Exclusion criteria: bone metabolic disease, endocrine disease, etc.


InterventionsExperimental: Erxian soup, 1 pack per day, for 6 months

Control: Caltrate, 1 tablet per day, for 6 months


OutcomesBMD, ALP, Ca, P


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wu MS 2001

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Kanggusong granule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: F-test, T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

90 postmenopausal osteoporosis patients enrolled: 30 in Kanggusong granule Tieji group, 30 in Kanggusong granule group, 30 in ipriflavone group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine diseases, etc.


InterventionsExperimental: Kanggusong granule, 12 g, twice a day, for 3 months

Control: ipriflavone, 1 tablet, 3 times a day, for 3 months


OutcomesE2, Ca, P, ALP, PTH


NotesThe study was supported by the National Natural Science Foundation, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Wu MS 2007

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of prescription for tonifying kidney in the treatment of osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

180 osteoporosis patients enrolled: 30 in prescription for tonifying kidney group, 30 in kidney meridian sticking group, 30 in urinary bladder meridian sticking group, 30 in ipriflavone group, 30 in Gushukang group, 30 in non-meridian or acupoint sticking group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, patients with fractures, etc.


InterventionsExperimental: prescription for tonifying kidney, 10 pills, 3 times a day; Kanggusong Tieji (kidney meridian sticking or urinary bladder meridian sticking), once per 2 days; for 6 months

Control: ipriflavone, 200 mg, 3 times a day, for 6 months


OutcomesBMD, Ca, P, E2, PTH, CT, adverse effects


NotesThe study was supported by the National Natural Science Foundation, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Wu W 2005

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Xianling Gubao capsules in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

68 postmenopausal osteoporosis patients enrolled: 34 in trial group, 34 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Xianling Gubao capsules (1 g, 3 times a day) and Caltrate (1 tablet per day), for 12 months

Control: Caltrate, 1 tablet per day, for 12 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Xiao W 2008

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Gusong decoction in the treatment of osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

40 osteoporosis patients enrolled: 20 in trial group, 20 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Gusong decoction (15 ml, 3 times a day) and alendronate sodium tablet (1 tablet per day), for 5 months

Control: alendronate sodium tablet, 1 tablet per day, for 5 months


OutcomesBMD, E2, ALP, IL-6, BGP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Xie J 2004

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Migu tablet in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: 21 drop-outs were not included in the analysis


ParticipantsEthnicity: Chinese

65 senile osteoporosis males enrolled (21 drop-out): 24 in trial group, 20 in control group

Inclusion criteria: diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: metabolic disease, etc.


InterventionsExperimental: Migu tablet (3 tablets, 3 times a day) and Caltrate (600 mg per day), for 1 year

Control: Caltrate, 600 mg per day, for 1 year


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
High riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Xie YM 1997

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Bugu Shengsui capsule in the treatment of primary osteoporosis

Study design: single-blind, randomised controlled trial

Analysis: T-test, Chi2 test, Ridit test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 primary osteoporosis patients with kidney-yang deficiency enrolled: 50 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by SPA and DXA

Exclusion criteria: secondary osteoporosis, endocrine disease, etc.


InterventionsExperimental: Bugu Shengsui capsule, 3 capsules, 3 times a day, for 6 months

Control: vitamin D2 (10,000 U per day) and calcium tablet (500 mg, 3 times a day), for 6 months


OutcomesBMD, Ca, ALP, PTH, CT, adverse effects


NotesThe study was supported by the state administration of traditional Chinese medicine youth fund, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Xiong YH 2008

MethodsCountry: China

Setting: hospital based

Aim: to study the effects of Gusongbao granule in the treatment of postmenopausal osteoporosis

Study design: double-blind, placebo-controlled, randomised controlled trial

Analysis: T-test

Loss to follow-up: 36 drop-outs (12 in Gusongbao granule group, 13 in placebo group, 11 in Jiangu granule group) were not included in the analysis


ParticipantsEthnicity: Chinese

144 postmenopausal osteoporosis patients enrolled: 48 (12 drop-outs) in Gusongbao granule group, 48 (13 drop-outs) in placebo group, 48 (11 drop-outs) in Jiangu granule group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease, etc.


InterventionsGusongbao granule group: Gusongbao granule, 1 dose, twice a day, Osteoform calcium amino acid chelate compound capsule, 1 pill, twice a day, for 6 months

Jiangu granule group: 1 dose, twice a day, Osteoform calcium amino acid chelate compound capsule, 1 pill, twice a day, for 6 months

Placebo group: 1 dose, twice a day, Osteoform calcium amino acid chelate compound capsule, 1 pill, twice a day


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Xu H 2010

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Qianggu capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 postmenopausal osteoporosis patients enrolled: 40 in trial group, 40 in control A group, 40 in control B group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: not mentioned


InterventionsExperimental: Qianggu capsule (1 capsule, 3 times a day) and alendronate sodium (70 mg per week)

Control A: alendronate sodium (70 mg per week)

Control B: Qianggu capsule (1 capsule, 3 times a day)


OutcomesBMD, adverse events


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskRandom numbers table

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Xu M 2009

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to study the effects of Xianlinggubao capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

156 postmenopausal osteoporosis patients enrolled: 52 in trial group, 52 in control A group, 52 in control B group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, disease-affected bone metabolism, endocrine disease, etc.


InterventionsExperimental: Xianlinggubao capsule (3 capsules, 3 times a day) and alendronate sodium (70 mg per week)

Control A: alendronate sodium (70 mg per week)

Control B: Xianlinggubao capsule (3 capsules, 3 times a day)


OutcomesBMD, adverse events


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskRandom numbers table

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Xu W 2005

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of Yishen Yanggan mixture in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

110 postmenopausal osteoporosis patients with liver-kidney deficiency enrolled: 60 in trial group, 50 in control group
Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Yishen Yanggan mixture, 50 ml, twice a day, for 6 months

Control: calcium gluconate, 4 tablets, 3 times a day, for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Xu YL 2007

MethodsCountry: China

Setting: outpatients

Aim: to study the effects of acupoint sticking of Migudan in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

96 primary osteoporosis patients enrolled: 48 in trial group, 48 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, endocrine disease


InterventionsExperimental: acupoint sticking of Migudan (3 times a week), for 3 months

Control: Gaitianli (3 tablets, 3 times a day), for 3 months


OutcomesBGP, Hyp, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Yang B 2007

MethodsCountry: China

Setting: inpatients

Aim: to study the effects of Huangqi in the treatment of osteoporosis

Study design: randomised controlled trial

Analysis: F-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

58 osteoporosis patients enrolled: 20 in trial group of Huangqi, 20 in control group of Liweiai, 18 in control group of blank Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: endocrine disease, liver or kidney disease, etc.


InterventionsExperimental: Huangqi, 1 dose per day, for 6 months

Control: Liweiai, 2.5 mg, once a day, for 6 months

Blank group: no drug


OutcomesBMD, ALP, P, Ca


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Ye AN 1998

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to observe the effects of Bushen Zhuanggutang in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 senile osteoporosis patients enrolled: 31 in trial group, 29 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Bushen Zhuanggutang (1 dose per day, fried) and Caltrate (1 tablet per day), for 6 months

Control: Caltrate (1 tablet per day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Yuan YN 2000

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Shangke Jiegu tablet in the treatment of primary osteoporosis

Study design: single-blinded, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 primary osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by SPA

Exclusion criteria: endocrine disease, etc.


InterventionsExperimental: Shangke Jiegu tablet, 4 tablets, 3 times a day, for 6 months

Control: vitamin D2 (10,000 U per day) and calcium tablet (500 mg, 3 times a day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Zhan HS 2009

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Xuduanzhuanggu capsule in the treatment of primary osteoporosis

Study design: double-blinded, placebo and positive-controlled, randomised controlled trial

Analysis: T-test

Loss to follow-up: 67 drop-outs (37 in herb trial group, 18 in positive control group, 21 in placebo group) were not included in the analysis


ParticipantsEthnicity: Chinese

600 primary osteoporosis patients enrolled: 360 in herb trial group (37 drop-outs), 120 in positive control group (18 drop-outs), 120 in placebo group (21 drop-outs)

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: secondary osteoporosis, disease-affected bone metabolism, metabolic disease, liver or kidney disease, etc.


InterventionsExperimental: Xuduanzhuanggu capsule (2 capsules, 3 times a day), Gusongbao granule placebo (1 packet, 3 times a day) and calcium tablet (1 tablet, once a day), for 6 months

Control: Xuduanzhuanggu capsule placebo (2 capsules, 3 times a day), Gusongbao granule (1 packet, 3 times a day) and calcium tablet (1 tablet, once a day), for 6 months

Placebo: Xuduanzhuanggu capsule placebo (2 capsules, 3 times a day), Gusongbao granule placebo (1 packet, 3 times a day) and calcium tablet (1 tablet, once a day), for 6 months


OutcomesBMD, adverse events


NotesThe study was supported by a National High Technology Research and Development Program, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskInsufficient information about the sequence generation process

Allocation concealmentUnclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Blinding
All outcomes
Low riskDouble-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Unclear riskInsufficient information about drop-outs

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhan ML 2007

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Bushen Yangxue decoction in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

40 postmenopausal osteoporosis patients enrolled: 20 in trial group, 20 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Bushen Yangxue decoction, 1 dose per day, for 6 months

Control: calcium gluconate, 4 tablets, 3 times a day, for 6 months


OutcomesCa, P


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhang DS 2011

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Bushenyiqihuoxue soup in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 postmenopausal osteoporosis patients enrolled: 60 in trial group, 60 in control group

Inclusion criteria: guiding principles for clinical research on new drugs in traditional Chinese medicine

Exclusion criteria: metabolic disease, etc.


InterventionsExperimental: Bushenyiqihuoxue soup (1 dose per day, water fried 600 ml, twice a day), tamoxifen (20 mg, once a day) and Caltrate (1 tablet, twice a day), for 3 months

Control: tamoxifen (20 mg, once a day) and Caltrate (1 tablet, twice a day), for 3 months


OutcomesALP, Ca


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo detailed description of the detection of BMD and biochemical indicators

Zhang J 2003

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Liuwei Dihuang pills in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

42 postmenopausal osteoporosis patients enrolled: 24 in trial group, 18 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Liuwei Dihuang pills, 8 pills, 3 times a day, for 12 months

Control: calcium, 500 mg per day, for 12 months


OutcomesBMD, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Zhang RH 2004

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Yigu capsule in the treatment of postmenopausal osteoporosis

Study design: double-blinded, randomised controlled trial

Analysis: F-test, Chi2 test

Loss to follow-up: 10 drop-outs were not included in the analysis


ParticipantsEthnicity: Chinese

210 postmenopausal osteoporosis patients enrolled: 70 (3 drop-outs) in herbal trial group, 70 (4 drop-outs) in control group, 70 (3 drop-outs) in placebo group

Inclusion criteria: WHO diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: metabolic disease, etc.


InterventionsExperimental: Yigu capsule (4 capsules, 3 times a day) and calcium (510 mg), for 6 months

Control: Alfacalcidol (1 capsule per day) and calcium (510 mg), or placebo and calcium (510 mg), for 6 months


OutcomesBMD, E2, Ca, P, ALP, BGP, fractures


NotesThe study was supported by the National Science Foundation and China Postdoctoral Science Foundation, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers generated by computer

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blinded

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhang XG 2011

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Bushenjianpi Zhuangguyin in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

100 primary osteoporosis patients enrolled: 50 in trial group, 50 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, disease-affected bone metabolism, etc.


InterventionsExperimental: Bushenjianpi Zhuangguyin, 1 dose per day, water fried, twice a day, for 12 weeks

Control: Caltrate, 600 mg, twice a day, and Miacalcin ampoule 50 IU, once a day, for 12 weeks


OutcomesBMD, Ca, P, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Zhang XJ 2008

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to observe the effects of Bushenhuoxue capsule in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test, F-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 senile osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease, disease-affected bone metabolism


InterventionsExperimental: Bushenhuoxue capsule, 4 pills, 3 times a day, for 12 months

Control: Caltrate, 600 mg, once a day and Rocaltrol, 0.5 mg, once a day, for 12 months


OutcomesBMD, E2, IL-6, BGP


NotesThe study was supported by the Zhejiang Provincial Department of traditional Chinese medicine (TCM) modernisation research project, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Zhang XZ 2004

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to observe the effects of Xianlinggubao capsule in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

178 postmenopausal osteoporosis patients enrolled: 62 in trial group (Xianlinggubao capsule), 66 in control group 1 (tibolone), 50 in control group 2 (Osteoform)

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: liver or kidney disease, disease-affected bone metabolism, etc.


InterventionsExperimental: Xianlinggubao capsule and Osteoform, 1.0 g, 3 times a day, for 48 weeks

Control 1:tibolone tablets and Osteoform, 1.25 mg, once a day

control 2: Osteoform, 1 g, once a day


OutcomesBMD, E2, ALP, BGP, IL-6


NotesThe study was supported by National Natural Science Foundation, but no declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskRandom numbers table

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Zhang YL 1996

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to observe the effects of TPF capsule in the treatment of senile osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 senile osteoporosis patients enrolled: 60 in trial group, 60 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis based on bone density levels, BMD detected by SPA

Exclusion criteria: not mentioned


InterventionsExperimental: TPF capsule, 3 to 4 capsules, 3 times a day, for 6 months

Control: calcium granule, 10 g, twice a day, for 6 months


OutcomesBMD, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

Zhang YP 2007

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Shigu yin in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, F-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

120 postmenopausal osteoporosis patients enrolled: 40 in Shigu yin group, 40 in Caltrate group, 40 in blank group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism, metabolic disease, etc.


InterventionsExperimental: Shigu yin, 200 ml, twice a day, for 6 months

Control: Caltrate, 600 mg, twice a day, for 6 months

blank: no treatment


OutcomesBMD, BGP, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhang YS 2003

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Huoluo Gukang pills in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

210 primary osteoporosis patients enrolled: 81 in herbal trial group, 74 in herbal control group, 55 in blank group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, etc.


InterventionsExperimental: Huoluo Gukang pills, 6.0 g, 3 times a day, for 6 months; Gushukang granule, 10.0 g, twice a day, for 6 months

Control: blank (no drug)


OutcomesE2, BGP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhang ZF 2011

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Zhuangguqiangjin tablet in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: 8 drop-outs (3 in trial group, 5 in control group) were not included in the analysis


ParticipantsEthnicity: Chinese

90 primary osteoporosis patients with deficiency of kidney and liver enrolled: 48 in trial group (3 drop-outs), 42 in control group (5 drop-outs)

Inclusion criteria: Chinese diagnostic criteria for primary osteoporosis, BMD detected by DXA

Exclusion criteria: diseases which can affect bone conversion biochemical index, etc.


InterventionsExperimental: Zhuangguqiangjin tablet (5, 3 times a day for 3 months, then twice a day for 1 year), Shujinbogu tablet (5 tablets, 3 times a day, for 2 to 4 weeks), Miacalcin ampoule (50 IU, injection, once every other day for 10 days; once every 2 days for 10 days; once every 5 days for 10 days. In the 3rd, 6th, 9th and 12th month repeated again)

Control: Miacalcin ampoule (50 IU, injection, once every other day for 10 days; once every 2 days for 10 days; once every 5 days for 10 days. In the 3rd, 6th, 9th and 12th month repeated again)


OutcomesBMD, Ca, P, ALP, adverse effects, fracture


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhao G 2002

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Zishen prescription in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

45 postmenopausal osteoporosis patients enrolled: 25 in trial group, 20 in control group

Inclusion criteria: international diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: diseases which can affect therapeutic effect


InterventionsExperimental: Zishen prescription (25 ml, twice a day), Caltrate (1.2 g, twice a day) and Miacalcin (50 IU, injection, twice weekly), for 8 months

Control: Caltrate (1.2 g, twice a day) and Miacalcin (50 IU, injection, twice weekly), for 8 months


OutcomesBMD, E2


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhao HX 2001

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Kanggusong capsule in the treatment of postmenopausal osteoporosis

Study design: double-blinded, placebo-controlled, randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: 35 drop-outs (11 in trial group, 16 in control group, 8 in opening experimental group) were not included in the analysis


ParticipantsEthnicity: Chinese

198 postmenopausal osteoporosis patients enrolled: 70 (11 drop-outs) in trial group, 70 (16 drop-outs) in control group, 58 (8 drop-outs) in opening experimental group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: diseases which can affect biochemical markers of bone turnover


InterventionsExperimental: Kanggusong capsule, 3 capsules, 3 times a day, for 1 year

Control: placebo, 3 capsules, 3 times a day, for 1 year


OutcomesBMD, fractures


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskComputer QBASIC procedure

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Unclear riskNo reasons for missing data provided

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhao LN 2003

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Yinyanghuo in the treatment of postmenopausal osteoporosis

Study design: double-blinded, randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

25 postmenopausal osteoporosis patients enrolled: 15 in trial group, 10 in control group

Inclusion criteria: diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: not mentioned


InterventionsExperimental: Yinyanghuo, fried, 200 g per day, 3 times a day, for 3 to 6 months

Control: Premarin, 0.625 mg per day, for 3 to 6 months


OutcomesBMD, Ca, P, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskNo information on baseline

Zheng WK 2007

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Jinwugutong capsules in the treatment of postmenopausal osteoporosis

Study design: double-blinded, placebo-controlled, randomised controlled trial

Analysis: T-test, F-test, Chi2 test

Loss to follow-up: 11 drop-outs (5 in trial group, 6 in control group) were not included in the analysis


ParticipantsEthnicity: Chinese

120 postmenopausal osteoporosis patients enrolled: 60 in trial group, 60 in control group

Inclusion criteria: WHO diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: disease-affected bone metabolism, used medicines that affected bone metabolism


InterventionsExperimental: Jinwugutong capsules (3 capsules, 3 times a day) plus calcium (510 mg per day), for 6 months

Control: placebo capsules (3 capsules, 3 times a day) plus calcium (510 mg per day), for 6 months


OutcomesBMD, BGP, ALP, Ca, P, adverse effect


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind but did not describe who was blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhong RQ 2007

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Gushen Yijing tang in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

80 primary osteoporosis patients enrolled: 39 in trial group, 41 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: endocrine disease, liver or kidney disease


InterventionsExperimental: Gushen Yijing tang (1 dose and 2 times a day), for 6 months

Control: Caltrate (600 mg, twice a day) for 6 months


OutcomesBMD, Ca, P, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhou LZ 2001

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Tongbu Qianggutang in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

40 primary osteoporosis patients enrolled: 30 in trial group, 10 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, liver or kidney disease, etc.


InterventionsExperimental: Tongbu Qianggutang (400 ml per day), for 3 months

Control: calcium (1.5 g, 3 times a day) plus vitamin D3 (0.25 μg per day), for 3 months


OutcomesALP, CT, BGP, Ca, P, E2, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhou XT 2001

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Guilu Erxiantang in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

85 primary osteoporosis patients enrolled: 45 in trial group, 40 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis based on bone density levels, BMD detected by DXA

Exclusion criteria: secondary osteoporosis


InterventionsExperimental: Guilu Erxiantang (1 dose per day) and calcium carbonate tablet (300 mg per day), for 6 months

Control: calcium carbonate tablet (300 mg per day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhou ZK 2006

MethodsCountry: China

Setting: outpatients and inpatients

Aim: to observe the effects of Huangqi Sanxian tang in the treatment of postmenopausal osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

50 postmenopausal osteoporosis patients enrolled: 30 in trial group, 20 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: bone metabolic disease induced by diabetes mellitus, liver or kidney disease


InterventionsExperimental: Huangqi Sanxian tang (1 dose per day), for 3 months

Control: nilestriol (2 mg, twice per month), for 3 months


OutcomesBMD, E2, ALP


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhu HJ 2011

MethodsCountry: China

Setting: inpatients

Aim: to observe the effects of Bushen Tianjing Huoxue therapy in the treatment of primary osteoporosis

Study design: randomised controlled trial

Analysis: T-test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

61 primary osteoporosis patients enrolled: 31 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis

Exclusion criteria: secondary osteoporosis, endocrine disease, liver or kidney disease, etc.


InterventionsExperimental: Bushen Tianjing Huoxue therapy (1 dose per day, twice a day), for 6 months

Control: Caltrate (600 mg, once a day) and calcitriol soft capsule (0.25 μg, once a day), for 6 months


OutcomesBMD


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zhu HM 2012

MethodsCountry: China

Setting: hospital based

Aim: to observe the effects of Bushen Tianjing Huoxue therapy in the treatment of primary osteoporosis

Study design: a multicentre, double-blinded, placebo-controlled, randomised controlled trial

Analysis: F-test, based on the intention-to-treat (ITT) principle

Loss to follow-up: 42 drop-outs (15 in low-dose Xianlinggubao group, 14 in high-dose Xianlinggubao group, 13 in placebo group)


ParticipantsEthnicity: Chinese

180 postmenopausal osteoporosis patients enrolled: 61 in low-dose Xianlinggubao group, 58 in high-dose Xianlinggubao group, 61 in placebo group

Inclusion criteria: BMD criteria for osteoporosis

Exclusion criteria: previous exposure to toremifene, tamoxifen, droloxifene, lasofoxifene or other investigational selective oestrogen receptor modulators; use of bisphosphonates during the past 24 months; history of advanced scoliosis, osteoarthritis or other clinical spinal deformity which would interfere with BMD measurement etc.


InterventionsExperimental: Xianlinggubao capsule, 3 g (6 capsules) per day in low-dose group, or 6 g (12 capsules) per day in high-dose group, plus calcium (500 mg) and vitamin D (200 IU), for 12 months

Control: placebo capsule (12 capsules per day), plus calcium (500 mg) and vitamin D (200 IU), for 12 months


OutcomesBMD, fracture, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom numbers

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskDouble-blind

Incomplete outcome data addressed
All outcomes
Unclear riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasLow riskThe study appears to be free of other sources of bias

Zou JJ 2005

MethodsCountry: China

Setting: outpatients

Aim: to observe the effects of Guben Zhuanggu capsules in the treatment of primary osteoporosis

Study design: single-blinded, randomised controlled trial

Analysis: T-test, Chi2 test

Loss to follow-up: not reported


ParticipantsEthnicity: Chinese

60 primary osteoporosis patients enrolled: 30 in trial group, 30 in control group

Inclusion criteria: Chinese diagnostic criteria for osteoporosis, BMD detected by DXA

Exclusion criteria: secondary osteoporosis, endocrine disease


InterventionsExperimental: Guben Zhuanggu capsules (2 capsules, 3 times a day) and Caltrate (600 mg, once a day), for 6 months

Control: Guben Zhuanggu capsules simulated (2 capsule, 3 times a day) and Caltrate (600 mg, once a day), for 6 months


OutcomesBMD, adverse effects


NotesNo funding sources or declarations of interest for the primary researchers reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding
All outcomes
Low riskSingle-blind

Incomplete outcome data addressed
All outcomes
Low riskNo missing outcome data

Free of selective reportingUnclear riskNot all the outcomes that were of interest in this review were reported

Free of other biasUnclear riskP value for the baseline comparison not stated

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Ai SC 2003Randomised controlled trial comparing herbal application Shenque (CV 8) with sodium etidronate in 70 primary osteoporosis patients. However, the herbal intervention was acupoint patch and did not meet the inclusion criteria

Ai SC 2003aNon-randomised study comparing herbal application Shenque with sodium etidronate in 70 patients with osteoporosis

Bo LY 2003Randomised controlled trial comparing Gushukang particles with calcium carbonate plus vitamin D in 94 cases with osteoporotic compression fracture of the spine. However, the outcome measure was general therapeutic effect based on different evaluated standards and did not meet the inclusion criteria

Chen AP 2005Randomised controlled trial comparing Liuwei Dihuang pills with Caltrate in 40 senile osteoporosis patients. However, the diagnosis of osteoporosis was not based on a BMD test

Chen JJ 2010Randomised controlled trial comparing Zini Bushenjiangu soup and routine western medicine treatment with routine western medicine treatment in 43 senile osteoporosis patients. However, the treatment duration was less than 3 months

Chen XF 2003Randomised controlled trial comparing Xianlinggubao plus vitamin D3 and calcium amino acid chelate with calcium gluconate in 150 osteoporosis patients. The trial intervention did not meet the inclusion criteria

Chen XF 2007Randomised controlled trial comparing Bushen Jianpi mixture with Caltrate in 64 senile primary osteoporosis patients. However, it did not report the part of BMD measured

Dai Y 2007aRandomised controlled trial comparing Migupian (68) and Xianlinggubao (50) with Caltrate (42) in 160 postmenopausal osteoporosis patients. However, the trial was published repeatedly

Deng WM 1997Randomised controlled trial comparing tonifying kidney to strength bone decoction with calcitonin in 135 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Deng WM 1997aRandomised controlled trial comparing kidney-tonifying herbs with calcitonin in 77 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Deng WM 2001The participants were not osteoporosis patients

Deng WM 2002Randomised controlled trial comparing Bushen Zhuanggu granule with calcitonin in 175 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Ding GZ 1995Randomised controlled trial comparing Bushen Jiangu capsule with calcium in 34 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Dong YL 2004Randomised controlled trial comparing Liuwei Dihuang pills plus calcium tablet and vitamin C with calcium tablet plus vitamin C in 60 senile osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and did not meet the inclusion criteria

Fan GF 2008Randomised controlled trial comparing Qiangjin Zhuanggu pill with oyster shell calcium chewable tablets in 248 primary osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Fan ZY 1995Randomised controlled trial comparing Yugu pill with nilestriol in 90 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Ge L 2005Randomised controlled trial comparing Jiangu pills with Caltrate in 40 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Gong L 2000Randomised controlled trial comparing traditional medicine (Yishen Zhuanggu mixture or Shengu capsule) with no treatment in 80 primary osteoporosis patients. However, it was a duplicate publication

Gong ZF 2011Randomised controlled trial comparing Bushenshujin soup and celecoxib capsules with celecoxib capsules in 90 primary osteoporosis patients. However, the treatment duration was 4 to 12 weeks

Gu M 2004Randomised controlled trial comparing Fortune's drynariae rhizome with calcium gluconate in 82 primary osteoporosis patients. However, it did not report the part of BMD measured

Gu T 2011Randomised controlled trial comparing Gushu recipes, calcium carbonate D3 and elcatonin injection with calcium carbonate D3 and elcatonin injection in 43 primary osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Guo F 2003Randomised controlled trial comparing Yishen Yanggan decoction with calcium gluconate in 60 osteoporosis patients. However, it did not report the part of BMD measured

Guo HN 1998Randomised controlled trial comparing Tiankui tang with gonadal hormone in 120 primary osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

He YC 2008Randomised controlled trial comparing Xianlinggubao capsule with salmon calcitonin in 88 senile osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Hu XD 2011Randomised controlled trial comparing Chinese Traditional Medicine recipe with high calcium tablets and Caltrate in 164 senile osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Jia JH 2010The type of interventions did not meet the inclusion criteria

Jiang SY 1995Randomised controlled trial comparing Gushukang granule with calcium tablet and vitamin D in 400 primary osteoporosis patients. However, it did not report the BMD of the ulna and radius respectively

Ke Q 2005Randomised controlled trial comparing Jiangu recipe preparation with alendronate sodium tablet in 70 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Ke Q 2005aRandomised controlled trial comparing Jiangu recipe preparation with alendronate sodium tablet in 95 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Li BL 2007aRandomised controlled trial comparing Jianshen prescription with alendronate sodium in 60 postmenopausal osteoporosis patients. However, it was a duplicate publication

Li CX 2005Randomised controlled trial comparing movement therapy plus Bushen Tongluo tang with Caltrate in 87 senile osteoporosis patients. The therapy intervention did not meet the inclusion criteria

Li JF 2008Randomised controlled trial comparing Bushen Qianggu tang plus calcium with calcium in 120 primary osteoporosis patients. However, the treatment duration was less than 3 months

Li YM 2005Non-randomised study comparing Bushen Huoxue preparation with Caltrate in 60 patients with postmenopausal osteoporosis

Lin HY 1998Randomised controlled trial comparing Yishen Jiangu tang with Caltrate in 40 primary osteoporosis patients. However, it was published repeatedly

Liu HB 2005Non-randomised study comparing medicine-separated sticking on Shenqu with sodium etidronate in 130 patients with primary osteoporosis

Liu HQ 2010The type of interventions did not meet the inclusion criteria

Liu TS 2008Randomised controlled trial comparing Traditional Chinese Medicine plus alfacalcidol soft capsule with alfacalcidol soft capsule in 124 primary osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Liu YS 2011Without control group

Liu YX 1998Randomised controlled trial comparing Fuguning granule with calcium tablet in 100 postmenopausal osteoporosis patients. However, it did not report the BMD of the ulna and radius respectively

Lu W 2004Randomised controlled trial comparing Bushen Jiangu tang with tibolone tablets in 80 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Lu ZD 2004Randomised controlled trial comparing Gushukang with nilestriol in 40 postmenopausal osteoporosis patients. However, it did not report the part of BMD measured

Luo QY 2011Without control group

Pan X 2004Non-randomised study comparing Huangqi injection to acupoint plus Caltrate with Caltrate in 64 patients with primary osteoporosis

Peng T 2003Non-randomised study comparing Qianggu extracts with calcium gluconate in 102 patients with postmenopausal osteoporosis

Qi ZX 2000Randomised controlled trial comparing Shengsuiyin with Caltrate in 40 primary osteoporosis patients. However, it was published repeatedly

Ren JH 2011Randomised controlled trial comparing Jinwugutong capsule and alendronate with alendronate in 90 postmenopausal osteoporosis patients. However, the outcome measure was general therapeutic effect about pain degree based on visual analogue scale (VAS) and it did not meet the inclusion criteria

Shang YM 2007Randomised controlled trial comparing Xianlinggubao capsule with conjugated oestrogens or calcium, or both, in 90 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Shi B 2010Randomised controlled trial comparing Traditional Chinese Medicine differentiation with calcium and vitamin D in 110 senile osteoporosis patients. However, it did not report the part of BMD measured

Shou ZX 2008Randomised controlled trial comparing Qianggu Huoli tablet plus Caltrate with Caltrate in 227 primary osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Shu J 2005Randomised controlled trial comparing Bushen Yijing prescription with calcium tablet in 50 cases of osteoporosis. The interventions in both arms were used for 7 weeks (less than 3 months)

Shuai B 2008Randomised controlled trial comparing Jiangu granule with Gusongbao granule in 96 primary osteoporosis patients. However, the control treatment did not meet the inclusion criteria

Song HX 2003Randomised controlled trial comparing Bushen Zhuanggu pill with calcium in 84 osteoporosis patients. However, it did not report the part of BMD measured

Song XW 1997Randomised controlled trial comparing Bushen herbal medicine with calcium in 55 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Song XW 2001Randomised controlled trial comparing Bushenhuoxue recipe with nilestriol or calcium in 68 postmenopausal osteoporosis patients. However, it was published repeatedly

Su CH 2004Randomised controlled trial comparing strong bone capsule with calcium carbonate plus vitamin D in 250 senile osteoporosis patients. However, the diagnostic method was not based on a BMD test

Su CH 2005Randomised controlled trial comparing strong bone capsule with Caltrate in 105 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Su YB 2008Randomised controlled trial comparing Qianggu Huoxue pill with Caltrate in 61 primary osteoporosis patients. However, the treatment duration was less than 3 months

Su ZW 2010Randomised controlled trial comparing Bushenzhuanggu soup, calcitriol capsule, calcium supplement with vitamin D chewable tablets, salcatonin injection and bone peptide injection with calcitriol capsule, calcium supplement with vitamin D chewable tablets, salcatonin injection and bone peptide injection in 110 primary osteoporosis patients. However, the treatment duration was less than 3 months

Sun JM 2002Randomised controlled trial comparing Yiqi Tiansui mixture plus Caltrate with Caltrate in 40 patients. However, this trial had the same data as the trial conducted by Mu G 2001

Sun X 2002Randomised controlled trial comparing Jiawei Zuogui pill with calcium in 90 patients. However, this trial had the same data as the trial conducted by Lv ZH

Sun YM 2008Randomised controlled trial comparing Gegen with alfacalcidol in 44 primary osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Tan X 2010The type of interventions did not meet the inclusion criteria

Tang JM 1999Randomised controlled trial comparing Jiangu powder with activated calcium powder in 98 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Tu PS 2008Randomised controlled trial comparing Bushen prescription with no treatment in 60 osteoporosis patients. However, the treatment duration was less than 3 months

Wang CH 2003Non-randomised study comparing Gusongkang capsule with calcium lactate in 100 patients with senile osteoporosis

Wang GH 2011Randomised controlled trial comparing Zhuanggutongluobao with vitamin D2 plus calcium tablet in 65 patients with primary osteoporosis. However, the comparability between groups was bad

Wang HM 1998Non-randomised study comparing Bugu capsule with activated calcium powder in 60 patients with senile osteoporosis

Wang J 2008Randomised controlled trial comparing Bugan Yishen tang with alfacalcidol in 65 postmenopausal osteoporosis patients. However, the treatment duration was less than 3 months

Wang JH 2001Randomised controlled trial comparing Qianggu pill with calcium lactate plus vitamin D in 120 osteoporosis patients. However, it was not clear that all were primary osteoporosis patients

Wang LM 2004Randomised controlled trial comparing Jiangu tang with Suplical in 99 senile osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Weng M 2003Randomised controlled trial comparing medicine-separated sticking on Shenque (RN8) with sodium etidronate in 70 primary osteoporosis patients. However, the herbal intervention was an acupoint patch and it did not meet the inclusion criteria

Wu CM 2004Randomised controlled trial comparing Bushen Zhuanggu capsule with diethylstilbestrol in 71 osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Wu D 2008Randomised controlled trial comparing Xiaoyao san plus Caltrate with Caltrate in 60 senile osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Wu XG 2008Randomised controlled trial comparing Xianlinggubao capsule with no treatment in 87 osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Xia WF 2006Unavailable data

Xie J 2001The participants were not patients with osteoporosis

Xie J 2003The participants were not patients with osteoporosis

Xu CY 2004Randomised controlled trial comparing Bushen Jianpi Tongluo decoction plus Yishen Jiangu tablet and Caltrate with Yishen Jiangu tablet and Caltrate in 125 primary osteoporosis patients. The interventions in both arms were used for 60 days (less than 3 months)

Xu LZ 2001Randomised controlled trial comparing Bupi Yishen Huoxue prescription with calcium or analgesic discontinuously in 130 osteoporosis patients. However, it was not clear that all were primary osteoporosis patients

Xu PH 2001Non-randomised study comparing Bushen Jiangu capsule with Gusongbao particles in 330 patients with osteoporosis

Yan XP 2007Without control group

Yang JP 2007Randomised controlled trial comparing Gushibao capsule with calcium tablet plus vitamin D in 105 osteoporosis patients. However, it was not clear that all were primary osteoporosis patients

Yang WH 2010The type of interventions did not meet the inclusion criteria

Yu YH 2011Randomised controlled trial comparing Erzhi pill with alendronate sodium tablets, Erzhi pill and alendronate sodium tablets with alendronate sodium tablets, in 60 postmenopausal osteoporosis patients. However, it did not report the part of BMD measured

Zhang GM 2001Randomised controlled trial comparing Xianguning powder with nilestriol in 80 postmenopausal osteoporosis patients. However, the diagnostic method was not based on a BMD test

Zhang H 1999Randomised controlled trial comparing Gubao capsule with Vita-D3 or Longmu Zhuanggu powder in 140 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Zhang WY 2005Randomised controlled trial comparing Bupi Yishen Huoxue prescription with oestradiol or testosterone in 45 senile osteoporosis patients. However, the outcome measure was general therapeutic effect based on different evaluated standards and it did not meet the inclusion criteria

Zhao G 2004Randomised controlled trial comparing Qianggu capsule with tibolone tablets in 69 postmenopausal osteoporosis patients. However, the diagnostic method was not reported definitively

Zhao Z 2010Randomised controlled trial comparing Yanghe capsule with Caltrate in 60 primary osteoporosis patients. However, it did not report the part of BMD measured

Zheng NX 2011The type of interventions did not meet the inclusion criteria

Zheng XH 2004Randomised controlled trial comparing Gukangye with calcium tablet in 150 primary osteoporosis patients. However, the diagnostic method was not based on a BMD test

Zheng ZW 2010Randomised controlled trial comparing Bushenzhuanggu soup plus western medicines (ossification alcohol capsule, calcium supplement with vitamin D chewable tablets, calcitonin and salmon calcitonin injection) with the same western medicines in 110 primary osteoporosis patients. However, the treatment duration was less than 3 months

Zhong J 2010Randomised controlled trial comparing Zhuanggubushen decoction plus carp calcitonin injection J with carp calcitonin injection in 50 osteoporosis patients. However, the treatment duration was less than 3 months and the participants did not meet the inclusion criteria

Zhong RQ 2007aRandomised controlled trial comparing Gushen Yijing tang with Caltrate in 79 osteoporotic fracture patients. However, the participants did not meet the inclusion criteria

Zhong RQ 2007bRandomised controlled trial comparing Gushen Yijing tang with Caltrate in 124 osteoporotic fracture patients. However, the participants did not meet the inclusion criteria

Zhou PQ 1997Non-randomised study comparing Migu tablet with nilestriol in 50 patients with postmenopausal osteoporosis

Zhu LP 2008Randomised controlled trial comparing Bushen Jianpi tang plus oyster shell calcium chewable tablets with oyster shell calcium chewable tablets in 80 postmenopausal osteoporosis patients. However, the treatment duration was less than 3 months

 
Comparison 1. Chinese herbal medicines versus placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 New fractures1104Risk Ratio (M-H, Fixed, 95% CI)0.05 [0.00, 0.85]

    1.1 Kanggusong capsule versus placebo (12 months)
1104Risk Ratio (M-H, Fixed, 95% CI)0.05 [0.00, 0.85]

 2 Bone mineral density (BMD)3Mean Difference (IV, Fixed, 95% CI)Subtotals only

    2.1 Migu decoction versus placebo (BMD of lumbar spine, 4 months)
120Mean Difference (IV, Fixed, 95% CI)0.16 [0.06, 0.26]

    2.2 Kanggusong capsule versus placebo (BMD of lumbar spine, 12 months)
1140Mean Difference (IV, Fixed, 95% CI)0.06 [0.02, 0.10]

    2.3 Bushen Yigu soft extract versus placebo (BMD of radius, 3 months)
159Mean Difference (IV, Fixed, 95% CI)0.06 [0.03, 0.09]

    2.4 Bushen Yigu soft extract versus placebo (BMD of ulna, 3 months)
159Mean Difference (IV, Fixed, 95% CI)0.06 [0.02, 0.10]

 3 Oestradiol (E2)1Mean Difference (IV, Random, 95% CI)Subtotals only

    3.1 Bushen Yigu soft extract versus placebo (3 months)
159Mean Difference (IV, Random, 95% CI)122.89 [92.97, 152.81]

 4 Symptoms including pain, muscle fatigue and limited mobility1104Risk Ratio (M-H, Fixed, 95% CI)1.20 [1.05, 1.37]

    4.1 Kanggusong capsule versus placebo (Bone pain at lumbar spine, 12 months)
1104Risk Ratio (M-H, Fixed, 95% CI)1.20 [1.05, 1.37]

 
Comparison 2. Chinese herbal medicines versus no intervention

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Bone mineral density (BMD)4Mean Difference (IV, Fixed, 95% CI)Subtotals only

    1.1 Bushen Shengsui principle versus no intervention (BMD of lumbar spine, 6 months)
161Mean Difference (IV, Fixed, 95% CI)0.07 [-0.06, 0.20]

    1.2 Bushen Shengsui principle versus no intervention (BMD of femoral neck, 6 months)
161Mean Difference (IV, Fixed, 95% CI)0.10 [-.00, 0.20]

    1.3 Qianggu soft extract versus no intervention (BMD of femoral neck, 6 months)
197Mean Difference (IV, Fixed, 95% CI)0.09 [0.03, 0.15]

    1.4 Shigu yin versus no treatment (BMD of Femoral neck, 6 months)
180Mean Difference (IV, Fixed, 95% CI)0.08 [0.03, 0.13]

    1.5 Yishen Zhuanggu mixture versus no intervention (BMD of femoral neck, 6months)
163Mean Difference (IV, Fixed, 95% CI)0.05 [-0.01, 0.11]

    1.6 Shengu capsule versus no intervention (BMD of femoral neck, 6 months)
134Mean Difference (IV, Fixed, 95% CI)0.02 [-0.06, 0.09]

 2 Oestradiol (E2)3Mean Difference (IV, Fixed, 95% CI)Subtotals only

    2.1 Bushen Shengsui principle versus no intervention (6 months)
161Mean Difference (IV, Fixed, 95% CI)4.40 [-4.61, 13.41]

    2.2 Yishen Zhuanggu mixture versus no treatment (6 months)
122Mean Difference (IV, Fixed, 95% CI)2.10 [-6.22, 10.42]

    2.3 Huoluo Gukang pills versus no intervention (6 months)
1136Mean Difference (IV, Fixed, 95% CI)2.40 [-1.22, 6.02]

    2.4 Gushukang granule versus no intervention (6 months)
1129Mean Difference (IV, Fixed, 95% CI)2.10 [-1.69, 5.89]

 3 Bone Gla protein (BGP)3Mean Difference (IV, Random, 95% CI)Subtotals only

    3.1 Yishen Zhuanggu mixture versus no treatment (6 months)
163Mean Difference (IV, Random, 95% CI)-1.0 [-6.15, 4.15]

    3.2 Shengu capsule versus no treatment (6 months)
134Mean Difference (IV, Random, 95% CI)-5.10 [-10.63, 0.43]

    3.3 Huoluo Gukang pills versus no treatment (6 months)
1136Mean Difference (IV, Random, 95% CI)2.70 [1.23, 4.17]

    3.4 Gushukang granule versus no treatment (6 months)
1129Mean Difference (IV, Random, 95% CI)3.5 [1.92, 5.08]

    3.5 Shigu yin versus no treatment (6 months)
180Mean Difference (IV, Random, 95% CI)1.2 [0.17, 2.23]

 
Comparison 3. Chinese herbal medicines versus western medicine

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 New fractures1142Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.1 Kanggusong granule versus Caltrate (9 months)
171Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.2 Kanggusong granule versus ipriflavone plus Caltrate (9 months)
171Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Bone mineral density (BMD)51Mean Difference (IV, Random, 95% CI)Subtotals only

    2.1 Kanggusong granule versus ipriflavone plus Caltrate (BMD of lumbar spine, 9 months)
171Mean Difference (IV, Random, 95% CI)0.0 [-0.05, 0.05]

    2.2 Kanggusong granule versus Caltrate (BMD of lumbar spine, 9 months)
171Mean Difference (IV, Random, 95% CI)0.04 [-0.02, 0.10]

    2.3 Kanggusong capsule versus Caltrate (BMD of lumbar spine, 6 months)
180Mean Difference (IV, Random, 95% CI)0.06 [0.02, 0.11]

    2.4 Strong Bone capsule versus Caltrate (BMD of lumbar spine, 3 months)
1105Mean Difference (IV, Random, 95% CI)-0.01 [-0.08, 0.06]

    2.5 Qianggu capsule versus active vitamin D3 (BMD of lumbar spine, 6 months)
154Mean Difference (IV, Random, 95% CI)0.04 [-0.01, 0.09]

    2.6 Qianggu capsule versus alendronate (BMD of lumbar spine, 6 months)
180Mean Difference (IV, Random, 95% CI)0.01 [-0.04, 0.05]

    2.7 Herba epimedii prescription versus vitamin D plus Caltrate (BMD of lumbar spine, 6 months)
180Mean Difference (IV, Random, 95% CI)0.03 [-0.00, 0.06]

    2.8 Bushen Shengsui principle versus conjugated oestrogens plus medroxyprogesterone (BMD of lumbar spine, 6 months)
166Mean Difference (IV, Random, 95% CI)0.0 [-0.12, 0.12]

    2.9 Bushen Qianggutang versus Caltrate (BMD of lumbar spine, 3 months)
140Mean Difference (IV, Random, 95% CI)0.09 [0.01, 0.17]

    2.10 Bushen Jianpi Migu prescription versus Caltrate (BMD of lumbar spine, 3 months)
1150Mean Difference (IV, Random, 95% CI)0.06 [0.03, 0.09]

    2.11 Bushen Jianpi Huoxue recipe versus alendronate sodium tablets (BMD of lumbar spine, 6 months)
1141Mean Difference (IV, Random, 95% CI)0.02 [-0.01, 0.05]

    2.12 Bushen Huoxue capsules versus Caltrate and Rocalirol (BMD of lumbar spine, 12 months)
160Mean Difference (IV, Random, 95% CI)0.02 [-0.05, 0.09]

    2.13 Bushen Zhuanggu tang versus alendronate sodium tablets (BMD of lumbar spine, 3 months)
160Mean Difference (IV, Random, 95% CI)0.04 [0.01, 0.07]

    2.14 Bushenjianpi Zhuangguyin versus Caltrate and calcitonin (BMD of lumbar spine, 12 weeks)
1100Mean Difference (IV, Random, 95% CI)0.16 [0.10, 0.22]

    2.15 Jiawei Bushen Zhuangjintang versus calcium granule (BMD of lumbar spine, 3 months)
190Mean Difference (IV, Random, 95% CI)0.10 [0.05, 0.15]

    2.16 Gukang oral liquid versus alendronate (BMD of lumbar spine, 6 months)
160Mean Difference (IV, Random, 95% CI)0.01 [-0.03, 0.05]

    2.17 Kidney-tonifying herbs versus nilestriol (BMD of lumbar spine, 6 months)
146Mean Difference (IV, Random, 95% CI)-0.02 [-0.09, 0.05]

    2.18 Kidney-tonifying herbs versus calcium (BMD of lumbar spine, 6 months)
146Mean Difference (IV, Random, 95% CI)0.02 [-0.04, 0.08]

    2.19 Yishen Yanggan mixture versus calcium gluconate (BMD of lumbar spine, 6 months)
1110Mean Difference (IV, Random, 95% CI)0.04 [0.01, 0.07]

    2.20 Yinyanghuo versus conjugated oestrogens (BMD of lumbar spine, 3 to 6 months)
125Mean Difference (IV, Random, 95% CI)0.03 [-0.04, 0.10]

    2.21 Shenyao capsules versus Caltrate (BMD of lumbar spine, 6 months)
1100Mean Difference (IV, Random, 95% CI)0.0 [-0.05, 0.05]

    2.22 Guli powder versus Caltrate (BMD of lumbar spine, 3 months, male)
130Mean Difference (IV, Random, 95% CI)0.02 [-0.01, 0.05]

    2.23 Guli powder versus Caltrate (BMD of lumbar spine, 3 months, female)
130Mean Difference (IV, Random, 95% CI)0.04 [-0.07, 0.15]

    2.24 Gushen Yijing tang versus Caltrate (BMD of lumbar spine, 6 months)
180Mean Difference (IV, Random, 95% CI)0.06 [-0.02, 0.14]

    2.25 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (BMD of lumbar spine, 6 months)
130Mean Difference (IV, Random, 95% CI)0.12 [-0.01, 0.26]

    2.26 Huangqi Sanxian tang versus nilestriol (BMD of lumbar spine, 3 months)
150Mean Difference (IV, Random, 95% CI)0.00 [-0.03, 0.04]

    2.27 Zishen Gukang pill versus Caltrate plus vitamin D (BMD of lumbar spine, 3 months)
160Mean Difference (IV, Random, 95% CI)-0.00 [-0.05, 0.04]

    2.28 Xianling Gusong capsules versus Caltrate (BMD of lumbar spine, 6 months)
143Mean Difference (IV, Random, 95% CI)-0.03 [-0.08, 0.02]

    2.29 Jianshenfang granule versus alendronate sodium (BMD of lumbar spine, 6 months)
160Mean Difference (IV, Random, 95% CI)0.09 [-0.03, 0.21]

    2.30 Jiangu recipe versus alendronate sodium tablets (BMD of lumbar spine, 12 months)
1120Mean Difference (IV, Random, 95% CI)0.02 [-0.00, 0.04]

    2.31 Gukang decoction versus alendronate sodium tablets (BMD of lumbar spine, 4 months)
183Mean Difference (IV, Random, 95% CI)-0.00 [-0.03, 0.03]

    2.32 Gumiling granule versus bicarbonate calcium chewable (BMD of lumbar spine, 6 months)
125Mean Difference (IV, Random, 95% CI)0.04 [-0.02, 0.09]

    2.33 Gujian capsule versus alfacalcidol (BMD of lumbar spine, 6 months)
165Mean Difference (IV, Random, 95% CI)0.14 [0.03, 0.26]

    2.34 Xianlinggubao capsule versus alendronate (BMD of lumbar spine, 6 months)
1104Mean Difference (IV, Random, 95% CI)0.0 [-0.02, 0.02]

    2.35 Erxian soup versus Caltrate (BMD of lumbar spine, 6 months)
158Mean Difference (IV, Random, 95% CI)0.06 [0.02, 0.11]

    2.36 Shangke Jiegu tablet versus vitamin D2 plus calcium tablet (BMD of lumbar spine, 6 months)
130Mean Difference (IV, Random, 95% CI)0.25 [0.11, 0.39]

    2.37 Gukang oral liquid versus calcium gluconate (BMD of radius, 6 months)
161Mean Difference (IV, Random, 95% CI)0.02 [0.01, 0.04]

    2.38 Herba epimedii prescription versus vitamin D plus Caltrate (BMD of radius, 6 months)
180Mean Difference (IV, Random, 95% CI)0.07 [0.04, 0.11]

    2.39 Bushen Yigu soft extract versus Alfacalcidol (BMD of radius, 3 months)
174Mean Difference (IV, Random, 95% CI)0.01 [-0.02, 0.04]

    2.40 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (BMD of radius, 6 months)
150Mean Difference (IV, Random, 95% CI)0.08 [-0.12, 0.28]

    2.41 Shangke Jiegu tablet versus vitamin D2 plus calcium tablet (BMD of radius, 6 months)
160Mean Difference (IV, Random, 95% CI)0.04 [-0.02, 0.11]

    2.42 Liuwei Dihuang pills versus calcium (BMD of radius, 12 months)
142Mean Difference (IV, Random, 95% CI)0.04 [0.03, 0.05]

    2.43 Gukang oral liquid versus calcium gluconate (BMD of ulna, 6 months)
161Mean Difference (IV, Random, 95% CI)0.0 [-0.02, 0.02]

    2.44 Bushen Yigu soft extract versus Alfacalcidol (BMD of ulna, 3 months)
174Mean Difference (IV, Random, 95% CI)0.02 [-0.01, 0.05]

    2.45 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (BMD of ulna, 6 months)
150Mean Difference (IV, Random, 95% CI)0.06 [-0.01, 0.13]

    2.46 Shangke Jiegu tablet versus vitamin D2 plus calcium tablet (BMD of ulna, 6 months)
160Mean Difference (IV, Random, 95% CI)0.05 [-0.00, 0.11]

    2.47 Liuwei Dihuang pills versus calcium (BMD of ulna, 12 months)
142Mean Difference (IV, Random, 95% CI)0.02 [0.01, 0.03]

    2.48 Kanggusong granule versus ipriflavone plus Caltrate (BMD of femoral neck, 9 months)
171Mean Difference (IV, Random, 95% CI)-0.01 [-0.04, 0.02]

    2.49 Kanggusong granule versus Caltrate (BMD of femoral neck, 9 months)
171Mean Difference (IV, Random, 95% CI)0.01 [-0.03, 0.05]

    2.50 Herba epimedii prescription versus vitamin D plus Caltrate (BMD of femoral neck, 6 months)
180Mean Difference (IV, Random, 95% CI)0.06 [0.02, 0.10]

    2.51 Bushen Shengsui principle versus conjugated oestrogens plus medroxyprogesterone (BMD of femoral neck, 6 months)
166Mean Difference (IV, Random, 95% CI)-0.01 [-0.11, 0.09]

    2.52 Kidney-tonifying herbs versus nilestriol (BMD of femoral neck, 6 months)
146Mean Difference (IV, Random, 95% CI)0.02 [-0.02, 0.06]

    2.53 Kidney-tonifying herbs versus calcium (BMD of femoral neck, 6 months)
146Mean Difference (IV, Random, 95% CI)0.05 [0.01, 0.09]

    2.54 Gumikang capsule versus calcium gluconate (BMD of femoral neck, 6 months)
160Mean Difference (IV, Random, 95% CI)0.02 [-0.04, 0.08]

    2.55 Yanghuo Sanzi tang versus Caltrate (BMD of femoral neck, 6 months)
160Mean Difference (IV, Random, 95% CI)0.05 [0.02, 0.08]

    2.56 Qianggu soft extract versus calcium gluconate (BMD of femoral neck, 6 months)
199Mean Difference (IV, Random, 95% CI)0.07 [0.02, 0.12]

    2.57 Qianggu capsules versus oestradiol valerate (BMD of femoral neck, 6 months)
190Mean Difference (IV, Random, 95% CI)0.02 [-0.02, 0.06]

    2.58 Qianggu paste versus calcium gluconate tablets (BMD of femoral neck, 6 months)
1123Mean Difference (IV, Random, 95% CI)0.07 [0.03, 0.11]

    2.59 Qianggu capsule versus active vitamin D3 (BMD of femoral neck, 6 months)
154Mean Difference (IV, Random, 95% CI)0.03 [-0.01, 0.07]

    2.60 Shigu yin versus Caltrate (BMD of femoral neck, 6 months)
180Mean Difference (IV, Random, 95% CI)0.03 [-0.01, 0.07]

    2.61 Jiangu capsule versus Caltrate (BMD of femoral neck, 12 months)
1125Mean Difference (IV, Random, 95% CI)0.04 [0.03, 0.06]

    2.62 Gujian capsule versus alfacalcidol (BMD of femoral neck, 6 months)
165Mean Difference (IV, Random, 95% CI)0.08 [0.03, 0.14]

    2.63 Bushenhuoxue capsules versus Caltrate and Rocalirol (BMD of femoral neck, 12 months)
160Mean Difference (IV, Random, 95% CI)0.02 [-0.06, 0.10]

    2.64 Bushenjianpi Zhuangguyin versus Caltrate and calcitonin (BMD of femoral neck, 12 weeks)
1100Mean Difference (IV, Random, 95% CI)0.06 [0.00, 0.12]

    2.65 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (BMD of femoral neck, 6 months)
130Mean Difference (IV, Random, 95% CI)0.09 [-0.05, 0.23]

    2.66 Shangke Jiegu tablet versus vitamin D2 plus calcium tablet (BMD of femoral neck, 6 months)
130Mean Difference (IV, Random, 95% CI)0.07 [-0.06, 0.20]

    2.67 Kanggusong granule versus ipriflavone plus Caltrate (BMD of Ward's, 9 months)
171Mean Difference (IV, Random, 95% CI)-0.03 [-0.07, 0.01]

    2.68 Kanggusong granule versus Caltrate (BMD of Ward's, 9 months)
171Mean Difference (IV, Random, 95% CI)0.0 [-0.04, 0.04]

    2.69 Kidney-tonifying herbs versus nilestriol (BMD of Ward's, 6 months)
146Mean Difference (IV, Random, 95% CI)0.06 [0.02, 0.10]

    2.70 Kidney-tonifying herbs versus calcium (BMD of Ward's, 6 months)
146Mean Difference (IV, Random, 95% CI)0.10 [0.06, 0.14]

    2.71 Gujian capsule versus alfacalcidol (BMD of Ward's, 6 months)
165Mean Difference (IV, Random, 95% CI)0.08 [0.01, 0.15]

    2.72 Qianggu capsule versus alendronate (BMD of Ward's, 6 months)
180Mean Difference (IV, Random, 95% CI)0.01 [-0.02, 0.03]

    2.73 Xianlinggubao capsule versus alendronate (BMD of Ward's, 6 months)
1104Mean Difference (IV, Random, 95% CI)-0.00 [-0.02, 0.02]

    2.74 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (BMD of Ward's, 6 months)
130Mean Difference (IV, Random, 95% CI)0.07 [-0.05, 0.19]

    2.75 Shangke Jiegu tablet versus vitamin D2 plus calcium tablet (BMD of Ward's, 6 months)
130Mean Difference (IV, Random, 95% CI)0.10 [-0.01, 0.22]

    2.76 Kanggusong granule versus ipriflavone plus Caltrate (BMD of trochanter, 9 months)
171Mean Difference (IV, Random, 95% CI)-0.01 [-0.05, 0.03]

    2.77 Kanggusong granule versus Caltrate (BMD of trochanter, 9 months)
171Mean Difference (IV, Random, 95% CI)0.03 [-0.00, 0.06]

    2.78 Gujian capsule versus alfacalcidol (BMD of trochanter, 6 months)
165Mean Difference (IV, Random, 95% CI)0.14 [0.07, 0.20]

    2.79 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (BMD of trochanter, 6 months)
130Mean Difference (IV, Random, 95% CI)0.11 [-0.04, 0.27]

    2.80 Shangke Jiegu tablet versus vitamin D2 plus calcium tablet (BMD of trochanter, 6 months)
130Mean Difference (IV, Random, 95% CI)0.19 [0.04, 0.33]

    2.81 Gushukang granule versus Calcium carbonate with vitamin D chewable tablets (BMD of hip bone, 6 months)
139Mean Difference (IV, Random, 95% CI)0.02 [-0.02, 0.06]

    2.82 Guli powder versus Caltrate (BMD of hip bone, 3 months, male)
130Mean Difference (IV, Random, 95% CI)0.0 [-0.04, 0.04]

    2.83 Guli powder versus Caltrate (BMD of hip bone, 3 months, female)
130Mean Difference (IV, Random, 95% CI)0.03 [-0.05, 0.11]

    2.84 TPF capsule versus calcium granule (BMD of distal radius, 6 months)
1120Mean Difference (IV, Random, 95% CI)0.20 [0.17, 0.23]

    2.85 Jiawei Zhuangyao Jianshen tang versus compound calcium amino acid chelate capsules (BMD of calcaneus, 3 months)
158Mean Difference (IV, Random, 95% CI)0.06 [0.01, 0.11]

    2.86 Liuwei Dihuang pills versus Caltrate (BMD of lumbar spine, 6 months)
171Mean Difference (IV, Random, 95% CI)0.05 [0.03, 0.07]

    2.87 Bushen Jianpi Jingu decoction versus calcitonin (BMD of lumbar spine, 3 months)
175Mean Difference (IV, Random, 95% CI)0.02 [-0.09, 0.13]

    2.88 Bushen Jianpi Jingu decoction versus calcitonin (BMD of femoral neck, 3 months)
175Mean Difference (IV, Random, 95% CI)0.05 [-0.02, 0.12]

    2.89 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (BMD of lumbar spine, 6 months)
164Mean Difference (IV, Random, 95% CI)0.05 [0.03, 0.07]

    2.90 Kangshu Jiangu granule versus Caltrate (BMD of femoral neck, 6 months)
176Mean Difference (IV, Random, 95% CI)0.08 [0.01, 0.15]

    2.91 Kangshu Jiangu granule versus Caltrate (BMD of lumbar spine, 6 months)
176Mean Difference (IV, Random, 95% CI)0.11 [0.01, 0.21]

    2.92 Bushen Tianjing Huoxue therapy versus Caltrate and calcitriol soft capsule (BMD of lumbar spine, 6 months)
161Mean Difference (IV, Random, 95% CI)0.04 [-0.00, 0.07]

 3 T score in BMD measurement2330Std. Mean Difference (IV, Random, 95% CI)0.11 [-0.12, 0.34]

    3.1 Jingujian granule versus Caltrate (T score, 3 months)
1120Std. Mean Difference (IV, Random, 95% CI)0.03 [-0.35, 0.41]

    3.2 Jingujian granule versus Caltrate (T score, 3 months)
1210Std. Mean Difference (IV, Random, 95% CI)0.16 [-0.12, 0.45]

 4 Symptoms including pain, muscle fatigue and limited mobility12Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    4.1 Jiawei Bushen Zhuangjintang versus calcium granule (3 months)
190Risk Ratio (M-H, Fixed, 95% CI)1.68 [1.28, 2.19]

    4.2 Qianggu soft extract versus calcium gluconate (6 months)
199Risk Ratio (M-H, Fixed, 95% CI)1.86 [1.24, 2.80]

    4.3 Kanggusong granule versus ipriflavone (3 months)
160Risk Ratio (M-H, Fixed, 95% CI)1.6 [1.07, 2.39]

    4.4 Yishen Yanggan mixture versus calcium gluconate (6 months)
1110Risk Ratio (M-H, Fixed, 95% CI)1.70 [1.28, 2.25]

    4.5 Yinyanghuo versus conjugated oestrogens (3 to 6 months)
125Risk Ratio (M-H, Fixed, 95% CI)0.96 [0.72, 1.28]

    4.6 Gumiling granule versus bicarbonate calcium chewable (6 months)
125Risk Ratio (M-H, Fixed, 95% CI)4.26 [1.43, 12.72]

    4.7 Jiawei Zhuangyao Jianshen tang versus compound calcium amino acid chelate capsules (3 months)
158Risk Ratio (M-H, Fixed, 95% CI)1.25 [0.94, 1.66]

    4.8 Zishen Gukang pill versus Caltrate plus vitamin D (3 months)
160Risk Ratio (M-H, Fixed, 95% CI)1.27 [1.01, 1.61]

    4.9 Xianling Gusong capsules versus Caltrate (3 months)
143Risk Ratio (M-H, Fixed, 95% CI)1.57 [1.03, 2.39]

    4.10 Kanggusong capsule versus Caltrate (6 months)
180Risk Ratio (M-H, Fixed, 95% CI)1.51 [1.12, 2.04]

    4.11 Jiangu recipe versus alendronate sodium tablets (12 months)
1120Risk Ratio (M-H, Fixed, 95% CI)1.65 [1.31, 2.08]

    4.12 Jingujian granule versus Caltrate (3 months)
1100Risk Ratio (M-H, Fixed, 95% CI)3.15 [1.89, 5.26]

 5 Oestradiol (E2)25Mean Difference (IV, Random, 95% CI)Subtotals only

    5.1 Kanggusong granule versus ipriflavone plus Caltrate (9 months)
171Mean Difference (IV, Random, 95% CI)12.17 [8.27, 16.07]

    5.2 Kanggusong granule versus Caltrate (9 months)
171Mean Difference (IV, Random, 95% CI)11.0 [6.97, 15.03]

    5.3 Strong Bone capsule versus Caltrate (3 months)
1105Mean Difference (IV, Random, 95% CI)10.46 [4.29, 16.63]

    5.4 Bushen Shengsui principle versus conjugated oestrogens plus medroxyprogesterone (6 months)
166Mean Difference (IV, Random, 95% CI)4.0 [-3.92, 11.92]

    5.5 Bushen Qiangshen pill versus Caltrate (3 months)
130Mean Difference (IV, Random, 95% CI)6.71 [-2.28, 15.70]

    5.6 Qianggu soft extract versus calcium gluconate (6 months)
199Mean Difference (IV, Random, 95% CI)4.20 [0.89, 7.51]

    5.7 Gukang oral liquid versus alendronate (6 months)
160Mean Difference (IV, Random, 95% CI)3.90 [-6.64, 14.44]

    5.8 Gumikang capsule versus calcium gluconate (6 months)
160Mean Difference (IV, Random, 95% CI)3.5 [1.14, 5.86]

    5.9 Bushen Yigu soft extract versus Alfacalcidol (3 months)
174Mean Difference (IV, Random, 95% CI)76.29 [31.19, 121.39]

    5.10 Kanggusong granule versus ipriflavone (3 months)
160Mean Difference (IV, Random, 95% CI)4.18 [-13.85, 22.21]

    5.11 Yanghuo Sanzi tang versus Caltrate (6 months)
160Mean Difference (IV, Random, 95% CI)23.07 [17.83, 28.31]

    5.12 Gusong recipe versus alendronate sodium tablets (5 months)
140Mean Difference (IV, Random, 95% CI)3.90 [-9.01, 16.81]

    5.13 Gushukang granule versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)13.98 [3.90, 24.06]

    5.14 Bushen Jianpi Huoxue recipe versus alendronate sodium tablets (6 months)
1141Mean Difference (IV, Random, 95% CI)3.15 [0.28, 6.02]

    5.15 Prescription for tonifying kidney versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)14.00 [3.68, 24.32]

    5.16 Kidney meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)11.99 [1.15, 22.83]

    5.17 Urinary bladder meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)17.99 [7.65, 28.33]

    5.18 Huangqi Sanxian tang versus nilestriol (3 months)
150Mean Difference (IV, Random, 95% CI)-32.97 [-39.42, -26.52]

    5.19 Gukang oral liquid versus alendronate sodium tablets (6 months)
170Mean Difference (IV, Random, 95% CI)5.09 [2.81, 7.37]

    5.20 Gukang decoction versus alendronate sodium tablets (4 months)
183Mean Difference (IV, Random, 95% CI)-0.65 [-9.04, 7.74]

    5.21 Jianshenfang granule versus alendronate sodium (6 months)
160Mean Difference (IV, Random, 95% CI)5.83 [4.21, 7.45]

    5.22 Jiangu recipe versus alendronate sodium tablets (6 months)
1120Mean Difference (IV, Random, 95% CI)5.82 [3.69, 7.95]

    5.23 Jiangu recipe versus alendronate sodium tablets (12 months)
1120Mean Difference (IV, Random, 95% CI)10.75 [8.55, 12.95]

    5.24 Bushen Zhuanggu tang versus alendronate sodium tablets (3 months)
160Mean Difference (IV, Random, 95% CI)5.37 [2.07, 8.67]

    5.25 Bushen Huoxue capsule versus Caltrate and Rocalirol (12 months)
159Mean Difference (IV, Random, 95% CI)2.13 [0.42, 3.84]

    5.26 Jingujian granule versus Caltrate (3 months)
1210Mean Difference (IV, Random, 95% CI)4.85 [4.56, 5.14]

    5.27 Qianggu paste versus calcium gluconate tablets (6 months)
1123Mean Difference (IV, Random, 95% CI)4.20 [1.79, 6.61]

    5.28 Tongbu Qianggutang versus calcium plus vitamin D3 (female, 3 months)
118Mean Difference (IV, Random, 95% CI)5.03 [-8.01, 18.07]

    5.29 Tongbu Qianggutang versus calcium plus vitamin D3 (male, 3 months)
122Mean Difference (IV, Random, 95% CI)1.89 [-17.98, 21.77]

    5.30 Gujian capsule versus alfacalcidol (6 months)
158Mean Difference (IV, Random, 95% CI)22.35 [-10.51, 55.21]

    5.31 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (6 months)
164Mean Difference (IV, Random, 95% CI)8.78 [0.92, 16.64]

 6 Serum calcium (Ca)22Mean Difference (IV, Random, 95% CI)Subtotals only

    6.1 Kanggusong granule versus ipriflavone plus Caltrate (9 months)
171Mean Difference (IV, Random, 95% CI)-0.09 [-0.17, -0.01]

    6.2 Kanggusong granule versus Caltrate (9 months)
171Mean Difference (IV, Random, 95% CI)-0.03 [-0.11, 0.05]

    6.3 Gushukang granule versus Calcium carbonate with vitamin D chewable tablets (6 months)
139Mean Difference (IV, Random, 95% CI)-0.02 [-0.10, 0.06]

    6.4 Strong Bone capsule versus Caltrate (3 months)
1105Mean Difference (IV, Random, 95% CI)-0.13 [-0.22, -0.04]

    6.5 Qianggu soft extract versus calcium gluconate (6 months)
199Mean Difference (IV, Random, 95% CI)-0.03 [-0.05, -0.01]

    6.6 Gumikang capsule versus calcium gluconate (6 months)
160Mean Difference (IV, Random, 95% CI)1.40 [1.39, 1.41]

    6.7 Bushen Jianpi Migu prescription versus Caltrate (3 months)
1150Mean Difference (IV, Random, 95% CI)0.01 [-0.05, 0.07]

    6.8 Kanggusong granule versus ipriflavone (3 months)
160Mean Difference (IV, Random, 95% CI)0.10 [0.03, 0.17]

    6.9 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (6 months)
144Mean Difference (IV, Random, 95% CI)0.10 [-0.05, 0.25]

    6.10 Yinyanghuo versus conjugated oestrogens (3 to 6 months)
125Mean Difference (IV, Random, 95% CI)0.54 [0.23, 0.85]

    6.11 Gushukang granule versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)-0.02 [-0.07, 0.03]

    6.12 Shenyao capsules versus Caltrate (6 months)
1100Mean Difference (IV, Random, 95% CI)0.02 [-0.08, 0.12]

    6.13 Guli powder versus Caltrate (3 months)
160Mean Difference (IV, Random, 95% CI)0.09 [0.02, 0.16]

    6.14 Prescription for tonifying kidney versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)0.0 [-0.05, 0.05]

    6.15 Kidney meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)-0.01 [-0.06, 0.04]

    6.16 Urinary bladder meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)-0.01 [-0.06, 0.04]

    6.17 Gushen Yijing tang versus Caltrate (6 months)
180Mean Difference (IV, Random, 95% CI)0.23 [0.11, 0.35]

    6.18 Gukang oral liquid versus alendronate sodium tablets (6 months)
170Mean Difference (IV, Random, 95% CI)-0.02 [-0.06, 0.02]

    6.19 Qianggu capsule versus active vitamin D3 (6 months)
154Mean Difference (IV, Random, 95% CI)0.01 [-0.06, 0.08]

    6.20 Jiangu capsule versus Caltrate (12 months)
1125Mean Difference (IV, Random, 95% CI)-0.06 [-0.11, -0.01]

    6.21 Bushen Yangxue tang versus calcium gluconate (6 months)
140Mean Difference (IV, Random, 95% CI)0.13 [-.00, 0.26]

    6.22 Bushenjianpi Zhuangguyin versus Caltrate and calcitonin (12 weeks)
1100Mean Difference (IV, Random, 95% CI)0.74 [0.66, 0.82]

    6.23 Erxian soup versus Caltrate (6 months)
158Mean Difference (IV, Random, 95% CI)-0.02 [-0.25, 0.21]

    6.24 Qianggu paste versus calcium gluconate tablets (6 months)
1123Mean Difference (IV, Random, 95% CI)-0.03 [-0.06, -0.00]

    6.25 Tongbu Qianggutang versus calcium plus vitamin D3 (3 months)
140Mean Difference (IV, Random, 95% CI)-0.02 [-0.10, 0.06]

    6.26 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (6 months)
164Mean Difference (IV, Random, 95% CI)-0.01 [-0.05, 0.03]

 7 Phosphorus (P)17Mean Difference (IV, Fixed, 95% CI)Subtotals only

    7.1 Kanggusong granule versus ipriflavone plus Caltrate (9 months)
171Mean Difference (IV, Fixed, 95% CI)0.06 [-0.03, 0.15]

    7.2 Kanggusong granule versus Caltrate (9 months)
171Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.29, 0.27]

    7.3 Gushukang granule versus Calcium carbonate with vitamin D chewable tablets (6 months)
139Mean Difference (IV, Fixed, 95% CI)0.01 [-0.09, 0.11]

    7.4 Strong Bone capsule versus Caltrate (3 months)
1105Mean Difference (IV, Fixed, 95% CI)-0.12 [-0.21, -0.03]

    7.5 Bushen Jianpi Migu prescription versus Caltrate (3 months)
1150Mean Difference (IV, Fixed, 95% CI)0.03 [-0.02, 0.08]

    7.6 Kanggusong granule versus ipriflavone (3 months)
160Mean Difference (IV, Fixed, 95% CI)-0.07 [-0.20, 0.06]

    7.7 Yinyanghuo versus conjugated oestrogens (3 to 6 months)
125Mean Difference (IV, Fixed, 95% CI)0.13 [-0.13, 0.39]

    7.8 Shenyao capsules versus Caltrate (6 months)
1100Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.08, 0.06]

    7.9 Gushukang granule versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.13, 0.11]

    7.10 Guli powder versus Caltrate (3 months)
160Mean Difference (IV, Fixed, 95% CI)-0.05 [-0.13, 0.03]

    7.11 Prescription for tonifying kidney versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-0.04 [-0.15, 0.07]

    7.12 Kidney meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.13, 0.11]

    7.13 Urinary bladder meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.13, 0.11]

    7.14 Gushen Yijing tang versus Caltrate (6 months)
180Mean Difference (IV, Fixed, 95% CI)0.04 [-0.09, 0.17]

    7.15 Qianggu capsule versus active vitamin D3 (6 months)
154Mean Difference (IV, Fixed, 95% CI)0.02 [-0.05, 0.09]

    7.16 Jiangu capsule versus Caltrate (12 months)
1125Mean Difference (IV, Fixed, 95% CI)0.09 [-0.20, 0.38]

    7.17 Bushenzhuanggu decoction versus alendronate sodium tablets (3 months)
160Mean Difference (IV, Fixed, 95% CI)0.24 [0.10, 0.38]

    7.18 Bushenjianpi Zhuangguyin versus Caltrate and calcitonin (12 weeks)
1100Mean Difference (IV, Fixed, 95% CI)-0.37 [-0.48, -0.26]

    7.19 Erxian soup versus Caltrate (6 months)
158Mean Difference (IV, Fixed, 95% CI)-0.03 [-0.20, 0.14]

    7.20 Tongbu Qianggutang versus calcium plus vitamin D3 (3 months)
140Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.12, 0.10]

    7.21 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (6 months)
164Mean Difference (IV, Fixed, 95% CI)0.0 [-0.15, 0.15]

 8 Alkaline phosphatase (ALP)32Mean Difference (IV, Fixed, 95% CI)Subtotals only

    8.1 Kanggusong granule versus ipriflavone plus Caltrate (9 months)
171Mean Difference (IV, Fixed, 95% CI)1.69 [0.79, 2.59]

    8.2 Kanggusong granule versus Caltrate (9 months)
171Mean Difference (IV, Fixed, 95% CI)1.28 [0.30, 2.26]

    8.3 Gushukang granule versus Calcium carbonate with vitamin D chewable tablets (6 months)
139Mean Difference (IV, Fixed, 95% CI)-0.5 [-1.70, 0.70]

    8.4 Strong Bone capsule versus Caltrate (3 months)
1105Mean Difference (IV, Fixed, 95% CI)-0.07 [-0.25, 0.11]

    8.5 Bushen Qiangshen pill versus Caltrate (3 months)
130Mean Difference (IV, Fixed, 95% CI)0.27 [-1.27, 1.81]

    8.6 Qianggu soft extract versus calcium gluconate (6 months)
199Mean Difference (IV, Fixed, 95% CI)3.60 [2.62, 4.58]

    8.7 Gukang oral liquid versus alendronate (6 months)
160Mean Difference (IV, Fixed, 95% CI)-1.06 [-2.54, 0.42]

    8.8 Gumikang capsule versus calcium gluconate (6 months)
160Mean Difference (IV, Fixed, 95% CI)3.41 [2.84, 3.98]

    8.9 Bushen Jianpi Migu prescription versus Caltrate (3 months)
1150Mean Difference (IV, Fixed, 95% CI)0.10 [0.01, 0.19]

    8.10 Kanggusong granule versus ipriflavone (3 months)
160Mean Difference (IV, Fixed, 95% CI)0.13 [-0.07, 0.33]

    8.11 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (6 months)
144Mean Difference (IV, Fixed, 95% CI)-0.29 [-1.67, 1.09]

    8.12 Liuwei Dihuang pills versus calcium (12 months)
142Mean Difference (IV, Fixed, 95% CI)0.55 [-0.12, 1.22]

    8.13 TPF capsule versus calcium granule (6 months)
1120Mean Difference (IV, Fixed, 95% CI)3.84 [2.53, 5.15]

    8.14 Yinyanghuo versus conjugated oestrogens (3 to 6 months)
125Mean Difference (IV, Fixed, 95% CI)-7.0 [-11.17, -2.83]

    8.15 Gusong recipe versus alendronate sodium tablets (5 months)
140Mean Difference (IV, Fixed, 95% CI)-1.05 [-2.86, 0.76]

    8.16 Shenyao capsules versus Caltrate (6 months)
1100Mean Difference (IV, Fixed, 95% CI)-2.40 [-3.58, -1.22]

    8.17 Bushen Jianpi Huoxue recipe versus alendronate sodium tablets (6 months)
1141Mean Difference (IV, Fixed, 95% CI)-2.94 [-4.34, -1.54]

    8.18 Guli powder versus Caltrate (3 months)
160Mean Difference (IV, Fixed, 95% CI)0.30 [-2.97, 3.57]

    8.19 Huangqi Sanxian tang versus nilestriol (3 months)
150Mean Difference (IV, Fixed, 95% CI)-0.03 [-1.14, 1.08]

    8.20 Gushen Yijing tang versus Caltrate (6 months)
180Mean Difference (IV, Fixed, 95% CI)2.17 [0.73, 3.61]

    8.21 Gukang oral liquid versus alendronate sodium Tablets
170Mean Difference (IV, Fixed, 95% CI)0.48 [-0.34, 1.30]

    8.22 Qianggu capsule versus active vitamin D3 (6 months)
154Mean Difference (IV, Fixed, 95% CI)0.71 [-1.17, 2.59]

    8.23 Jiangu capsule versus Caltrate (12 months)
1125Mean Difference (IV, Fixed, 95% CI)2.04 [1.32, 2.76]

    8.24 Jianshenfang granule versus alendronate sodium tablets (3 months)
160Mean Difference (IV, Fixed, 95% CI)0.33 [-2.79, 3.45]

    8.25 Jingujian granule versus Caltrate (3 months)
1120Mean Difference (IV, Fixed, 95% CI)0.53 [-0.69, 1.75]

    8.26 Jianshenfang granule versus alendronate sodium tablets (6 months)
160Mean Difference (IV, Fixed, 95% CI)0.33 [-2.78, 3.44]

    8.27 Bushen Zhuanggu tang versus alendronate sodium tablets (3 months)
160Mean Difference (IV, Fixed, 95% CI)-0.11 [-0.99, 0.77]

    8.28 Bushenjianpi Zhuangguyin versus Caltrate and calcitonin (12 weeks)
1100Mean Difference (IV, Fixed, 95% CI)-0.82 [-2.83, 1.19]

    8.29 Jingujian granule versus Caltrate (3 months)
1210Mean Difference (IV, Fixed, 95% CI)2.40 [2.21, 2.59]

    8.30 Erxian soup versus Caltrate (6 months)
158Mean Difference (IV, Fixed, 95% CI)0.0 [-0.87, 0.87]

    8.31 Qianggu paste versus calcium gluconate tablets (6 months)
1123Mean Difference (IV, Fixed, 95% CI)3.60 [2.86, 4.34]

    8.32 Bushen Yangxue tang versus calcium gluconate (6 months)
140Mean Difference (IV, Fixed, 95% CI)2.62 [0.84, 4.40]

    8.33 Tongbu Qianggutang versus calcium plus vitamin D3 (3 months)
140Mean Difference (IV, Fixed, 95% CI)0.18 [-1.08, 1.44]

    8.34 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (6 months)
164Mean Difference (IV, Fixed, 95% CI)0.91 [0.15, 1.67]

 9 Bone Gla protein (BGP)14Mean Difference (IV, Random, 95% CI)Subtotals only

    9.1 Bushen Jianpi Huoxue recipe versus alendronate sodium tablets (6 months)
1141Mean Difference (IV, Random, 95% CI)-2.13 [-2.74, -1.52]

    9.2 Acupoint sticking of Migudan versus oyster shell calcium chewable tablets (3 months)
196Mean Difference (IV, Random, 95% CI)1.55 [1.24, 1.86]

    9.3 Gukang oral liquid versus alendronate (6 months)
160Mean Difference (IV, Random, 95% CI)-0.10 [-0.93, 0.73]

    9.4 Gusong recipe versus alendronate sodium tablets (5 months)
140Mean Difference (IV, Random, 95% CI)-0.10 [-1.11, 0.91]

    9.5 Yanghuo Sanzi tang versus Caltrate (6 months)
160Mean Difference (IV, Random, 95% CI)2.71 [-0.30, 5.72]

    9.6 Strong Bone capsule versus Caltrate (3 months)
1105Mean Difference (IV, Random, 95% CI)-0.49 [-2.17, 1.19]

    9.7 Shigu yin versus Caltrate (6 months)
180Mean Difference (IV, Random, 95% CI)0.80 [-0.34, 1.94]

    9.8 Jingujian granule versus Caltrate (3 months)
1120Mean Difference (IV, Random, 95% CI)2.53 [-0.38, 5.44]

    9.9 Jianshenfang granule versus alendronate sodium (6 months)
160Mean Difference (IV, Random, 95% CI)0.49 [-1.59, 2.57]

    9.10 Jiangu recipe versus alendronate sodium tablets (12 months)
1120Mean Difference (IV, Random, 95% CI)1.81 [-0.31, 3.93]

    9.11 Bushen Huoxue capsules versus Caltrate and Rocalirol (12 months)
160Mean Difference (IV, Random, 95% CI)0.93 [0.35, 1.51]

    9.12 Kanggusong capsule versus Caltrate (6 months)
180Mean Difference (IV, Random, 95% CI)1.78 [0.40, 3.16]

    9.13 Liuwei Dihuang pills versus calcium (12 months)
142Mean Difference (IV, Random, 95% CI)17.9 [12.43, 23.37]

    9.14 Tongbu Qianggutang versus calcium plus vitamin D3 (3 months)
140Mean Difference (IV, Random, 95% CI)-1.50 [-5.07, 2.08]

 10 Interleukin-6 (IL-6)7Mean Difference (IV, Fixed, 95% CI)Subtotals only

    10.1 Bushen Jianpi Huoxue recipe versus alendronate sodium tablets (6 months)
1141Mean Difference (IV, Fixed, 95% CI)-5.72 [-14.05, 2.61]

    10.2 Gukang oral liquid versus alendronate (6 months)
160Mean Difference (IV, Fixed, 95% CI)-3.5 [-15.93, 8.93]

    10.3 Yanghuo Sanzi tang versus Caltrate (6 months)
160Mean Difference (IV, Fixed, 95% CI)-20.29 [-35.67, -4.91]

    10.4 Jianshenfang granule versus alendronate sodium (6 months)
160Mean Difference (IV, Fixed, 95% CI)-12.56 [-29.26, 4.14]

    10.5 Jiangu recipe versus alendronate sodium tablets (12 months)
1120Mean Difference (IV, Fixed, 95% CI)-19.99 [-30.92, -9.06]

    10.6 Bushen Huoxue capsules versus Caltrate and Rocalirol (12 months)
160Mean Difference (IV, Fixed, 95% CI)-18.70 [-34.16, -3.24]

    10.7 Gusong recipe versus alendronate sodium tablets (5 months)
140Mean Difference (IV, Fixed, 95% CI)-3.5 [-18.72, 11.72]

 11 Parathyroid hormone (PTH)6Mean Difference (IV, Fixed, 95% CI)Subtotals only

    11.1 Prescription for tonifying kidney versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-13.0 [-41.67, 15.67]

    11.2 Kidney meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-13.01 [-41.95, 15.93]

    11.3 Urinary bladder meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-3.01 [-31.44, 25.42]

    11.4 Kanggusong granule versus ipriflavone (3 months)
160Mean Difference (IV, Fixed, 95% CI)11.81 [-14.64, 38.26]

    11.5 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (6 months)
144Mean Difference (IV, Fixed, 95% CI)-10.63 [-140.92, 119.66]

    11.6 TPF capsule versus calcium granule (6 months)
1120Mean Difference (IV, Fixed, 95% CI)-254.0 [-399.06, -108.94]

    11.7 Gujian capsule versus alfacalcidol (6 months)
148Mean Difference (IV, Fixed, 95% CI)-22.57 [-60.92, 15.78]

    11.8 Gushukang granule versus ipriflavone (6 months)
160Mean Difference (IV, Fixed, 95% CI)-3.02 [-30.91, 24.87]

    11.9 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (6 months)
164Mean Difference (IV, Fixed, 95% CI)-2.06 [-6.74, 2.62]

 12 Computed tomography (CT)8Mean Difference (IV, Random, 95% CI)Subtotals only

    12.1 Prescription for tonifying kidney versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)0.96 [-3.71, 5.63]

    12.2 Kidney meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)-1.01 [-5.44, 3.42]

    12.3 Urinary bladder meridian sticking versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)-0.01 [-4.68, 4.66]

    12.4 Bugu Shengsui capsule versus vitamin D2 plus calcium tablet (6 months)
144Mean Difference (IV, Random, 95% CI)15.93 [-24.16, 56.02]

    12.5 Strong Bone capsule versus Caltrate (3 months)
1105Mean Difference (IV, Random, 95% CI)16.25 [10.43, 22.07]

    12.6 Jingujian granule versus Caltrate (3 months)
1210Mean Difference (IV, Random, 95% CI)21.98 [17.01, 26.95]

    12.7 TPF capsule versus Calcium granule (6 months)
1120Mean Difference (IV, Random, 95% CI)17.71 [11.53, 23.89]

    12.8 Tongbu Qianggutang versus calcium plus vitamin D3 (3 months)
140Mean Difference (IV, Random, 95% CI)-6.18 [-12.89, 0.52]

    12.9 Gujian capsule versus alfacalcidol (6 months)
157Mean Difference (IV, Random, 95% CI)-12.77 [-70.92, 45.38]

    12.10 Gushukang granule versus ipriflavone (6 months)
160Mean Difference (IV, Random, 95% CI)-0.01 [-4.44, 4.42]

    12.11 Radix rehmanniae preparata and Radix astragali versus calcium carbonate tablets (6 months)
164Mean Difference (IV, Random, 95% CI)0.11 [-0.04, 0.26]

 
Comparison 4. Chinese herbal medicines plus western medicine versus western medicine

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 New fractures5Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Yigu capsule plus calcium versus placebo plus calcium (6 months)
1140Risk Ratio (M-H, Fixed, 95% CI)0.06 [0.00, 1.00]

    1.2 Xianlinggubao capsule (low-dose) plus calcium and vitamin D versus placebo plus calcium and vitamin D (12 months)
1120Risk Ratio (M-H, Fixed, 95% CI)0.33 [0.01, 8.02]

    1.3 Xianlinggubao capsule (high-dose) plus calcium and vitamin D versus placebo plus calcium and vitamin D (12 months)
1116Risk Ratio (M-H, Fixed, 95% CI)0.36 [0.01, 8.58]

    1.4 Bushen Zhuanggu granules plus calcium and vitamin D versus placebo granules plus calcium and vitamin D (5 years)
1155Risk Ratio (M-H, Fixed, 95% CI)0.44 [0.13, 1.43]

    1.5 Kanggusong soup plus Caltrate versus Caltrate (3 months)
175Risk Ratio (M-H, Fixed, 95% CI)0.22 [0.01, 5.34]

    1.6 Zhuangguqiangjin tablet and Shujinbogu tablet plus calcitonin versus calcitonin (12 months)
190Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Bone mineral density (BMD)43Mean Difference (IV, Random, 95% CI)Subtotals only

    2.1 Gushen decoction plus Caltrate and Alfacalcidol versus Caltrate and Alfacalcidol (BMD of lumbar spine, 6 months)
164Mean Difference (IV, Random, 95% CI)0.06 [0.01, 0.11]

    2.2 Jiarong tablet plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
141Mean Difference (IV, Random, 95% CI)0.04 [-0.05, 0.14]

    2.3 Ziyin Bushen Zhuanggu prescription plus Caltrate and calcitonin versus Caltrate plus calcitonin (BMD of lumbar spine, 8 months)
145Mean Difference (IV, Random, 95% CI)0.14 [0.08, 0.20]

    2.4 Zhuanggu capsule plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
160Mean Difference (IV, Random, 95% CI)0.01 [0.00, 0.02]

    2.5 Antai capsule plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
1128Mean Difference (IV, Random, 95% CI)0.04 [-0.00, 0.08]

    2.6 Bushen Zhuanggutang plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
160Mean Difference (IV, Random, 95% CI)0.14 [0.06, 0.22]

    2.7 Zishen prescription plus Caltrate and calcitonin versus Caltrate plus calcitonin (BMD of lumbar spine, 8 months)
145Mean Difference (IV, Random, 95% CI)0.14 [0.08, 0.20]

    2.8 Guilu Erxiantang plus calcium carbonate tablet versus calcium carbonate tablet (BMD of lumbar spine, 6 months)
185Mean Difference (IV, Random, 95% CI)0.03 [-0.03, 0.09]

    2.9 Guben Zhuanggu capsules plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
160Mean Difference (IV, Random, 95% CI)0.03 [0.01, 0.05]

    2.10 Migu tablet plus Caltrate versus Caltrate (BMD of Lumbar spine, 12 months)
144Mean Difference (IV, Random, 95% CI)0.08 [0.07, 0.09]

    2.11 Shugan zishen huoxue tang plus Caltrate and alendronate sodium versus Caltrate plus alendronate sodium (BMD of lumbar spine, 6 months)
142Mean Difference (IV, Random, 95% CI)0.12 [0.08, 0.16]

    2.12 Bushen Yangxue tang plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
160Mean Difference (IV, Random, 95% CI)0.02 [-0.02, 0.06]

    2.13 Bushen Kangsong pill plus calcium carbonate tablets versus calcium carbonate tablets (BMD of lumbar spine, 6 months)
184Mean Difference (IV, Random, 95% CI)0.01 [-0.03, 0.04]

    2.14 Gusongbao granule plus compound calcium amino acid chelate capsule versus placebo granule plus compound calcium amino acid chelate capsule (BMD of lumbar spine, 6 months)
196Mean Difference (IV, Random, 95% CI)-0.01 [-0.07, 0.05]

    2.15 Qianggu capsule plus alendronate versus alendronate (BMD of lumbar spine, 6 months)
180Mean Difference (IV, Random, 95% CI)0.08 [0.03, 0.12]

    2.16 Xianlinggubao capsule plus Caltrate versus Caltrate (BMD of lumbar spine, 12 months)
168Mean Difference (IV, Random, 95% CI)0.30 [0.25, 0.35]

    2.17 Xianlinggubao capsule plus salmon calcitonin and Caltrate versus salmon calcitonin plus Caltrate (BMD of lumbar spine, 3 months)
1107Mean Difference (IV, Random, 95% CI)0.03 [-0.03, 0.09]

    2.18 Xianlinggubao capsule plus alendronate versus alendronate (BMD of lumbar spine, 6 months)
1104Mean Difference (IV, Random, 95% CI)0.06 [0.03, 0.09]

    2.19 Xianlinggubao capsule plus vitamin D3 and calcium amino acid chelate versus vitamin D3 and calcium amino acid chelate (BMD of lumbar spine, 48 weeks)
1112Mean Difference (IV, Random, 95% CI)0.01 [-0.03, 0.06]

    2.20 Xianlinggubao capsule plus Caltrate versus Caltrate (BMD of lumbar spine, 12 months)
1136Mean Difference (IV, Random, 95% CI)0.31 [0.28, 0.34]

    2.21 Xianlinggubao capsule plus compound calcium amino acid chelate capsule versus compound calcium amino acid chelate capsule (BMD of lumbar spine, 6 months)
1106Mean Difference (IV, Random, 95% CI)0.18 [0.14, 0.22]

    2.22 Jiangu granule plus compound calcium amino acid chelate capsule versus placebo granule plus compound calcium amino acid chelate capsule (BMD of lumbar spine, 6 months)
196Mean Difference (IV, Random, 95% CI)0.04 [-0.02, 0.10]

    2.23 Jinwugutong capsules plus calcium versus placebo plus calcium (BMD of lumbar spine, 6 months)
1120Mean Difference (IV, Random, 95% CI)0.11 [0.07, 0.15]

    2.24 Xuduanzhuanggu capsule plus calcium tablet versus placebo plus calcium tablet (BMD of lumbar spine, 6 months)
1480Mean Difference (IV, Random, 95% CI)0.02 [-0.01, 0.05]

    2.25 Chinese medicine Bushenhuoxue recipe plus conventional western medicine versus conventional western medicine (BMD of lumbar spine, 3 months)
157Mean Difference (IV, Random, 95% CI)0.16 [0.09, 0.22]

    2.26 Gusongbao granule plus calcium tablet versus placebo plus calcium tablet (BMD of lumbar spine, 6 months)
1240Mean Difference (IV, Random, 95% CI)-0.01 [-0.05, 0.03]

    2.27 Shengsuiyin recipe plus Caltrate versus Caltrate (BMD of Lumbar spine, 12 months)
1144Mean Difference (IV, Random, 95% CI)0.31 [0.28, 0.34]

    2.28 Yigu capsule plus calcium versus placebo plus calcium (BMD of lumbar spine, 6 months)
1140Mean Difference (IV, Random, 95% CI)0.08 [0.04, 0.12]

    2.29 Chinese medicine (combination of 10 herbs) plus tamoxifen and Caltrate versus tamoxifen and Caltrate (BMD of lumbar spine, 3 months)
1120Mean Difference (IV, Random, 95% CI)0.10 [0.06, 0.14]

    2.30 Zhuangguqiangjin tablet and Shujinbogu tablet plus calcitonin versus calcitonin (BMD of lumbar spine, 12 months)
190Mean Difference (IV, Random, 95% CI)0.01 [-0.04, 0.06]

    2.31 Migu tablet plus compound calcium amino acid chelate capsule versus compound calcium amino acid chelate capsule (BMD of lumbar spine, 6 months)
1107Mean Difference (IV, Random, 95% CI)0.17 [0.14, 0.20]

    2.32 Huangqi plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
136Mean Difference (IV, Random, 95% CI)0.06 [0.01, 0.11]

    2.33 Jiarong tablet plus Caltrate versus Caltrate (BMD of femoral neck, 6 months)
141Mean Difference (IV, Random, 95% CI)0.09 [0.02, 0.15]

    2.34 Antai capsule plus Caltrate versus Caltrate (BMD of femoral neck, 6 months)
1128Mean Difference (IV, Random, 95% CI)0.01 [-0.02, 0.04]

    2.35 Xianlinggubao capsule plus Caltrate versus Caltrate (BMD of femoral neck, 12 months)
168Mean Difference (IV, Random, 95% CI)0.3 [0.25, 0.35]

    2.36 Guben Zhuanggu capsules plus Caltrate versus Caltrate (BMD of femoral neck, 6 months)
160Mean Difference (IV, Random, 95% CI)0.01 [-0.01, 0.02]

    2.37 Migu tablet plus Caltrate versus Caltrate (BMD of femoral neck, 12 months)
144Mean Difference (IV, Random, 95% CI)0.09 [0.08, 0.10]

    2.38 Qianggu capsules plus oestradiol valerate versus oestradiol valerate (BMD of femoral neck, 6 months)
188Mean Difference (IV, Random, 95% CI)0.03 [-0.01, 0.07]

    2.39 Chinese medicine Bushenhuoxue recipe plus conventional western medicine versus conventional western medicine (BMD of femoral neck, 3 months)
157Mean Difference (IV, Random, 95% CI)0.17 [0.12, 0.23]

    2.40 Heche Dazao pill plus oyster shell calcium chewable tablets versus oyster shell calcium chewable tablets (BMD of femoral neck, 3 months)
1114Mean Difference (IV, Random, 95% CI)0.04 [0.00, 0.07]

    2.41 Xianlinggubao capsule plus compound calcium amino acid chelate capsule versus compound calcium amino acid chelate capsule (BMD of femoral neck, 6 months)
1106Mean Difference (IV, Random, 95% CI)0.26 [0.22, 0.30]

    2.42 Huangqi plus Caltrate versus Caltrate (BMD of femoral neck, 6 months)
136Mean Difference (IV, Random, 95% CI)0.07 [0.03, 0.11]

    2.43 Gusongbao granule plus compound calcium amino acid chelate capsule versus placebo granule plus compound calcium amino acid chelate capsule (BMD of femoral neck, 6 months)
196Mean Difference (IV, Random, 95% CI)0.01 [-0.03, 0.05]

    2.44 Jiangu granule plus compound calcium amino acid chelate capsule versus placebo granule plus compound calcium amino acid chelate capsule (BMD of femoral neck, 6 months)
196Mean Difference (IV, Random, 95% CI)-0.02 [-0.07, 0.03]

    2.45 Xuduanzhuanggu capsule plus calcium tablet versus placebo plus calcium tablet (BMD of femoral neck, 6 months)
1480Mean Difference (IV, Random, 95% CI)0.01 [-0.01, 0.03]

    2.46 Gusongbao granule plus calcium tablet versus placebo plus calcium tablet (BMD of femoral neck, 6 months)
1240Mean Difference (IV, Random, 95% CI)0.0 [-0.03, 0.03]

    2.47 Yigu capsule plus calcium versus placebo plus calcium (BMD of femoral neck, 6 months)
1140Mean Difference (IV, Random, 95% CI)0.04 [0.01, 0.07]

    2.48 Migu tablet plus compound calcium amino acid chelate capsule versus compound calcium amino acid chelate capsule (BMD of femoral neck, 6 months)
1107Mean Difference (IV, Random, 95% CI)0.24 [0.21, 0.27]

    2.49 Antai capsule plus Caltrate versus Caltrate (BMD of Ward's, 6 months)
1128Mean Difference (IV, Random, 95% CI)0.0 [-0.03, 0.03]

    2.50 Migu tablet plus Caltrate versus Caltrate (BMD of Ward's, 12 months)
144Mean Difference (IV, Random, 95% CI)0.09 [0.08, 0.10]

    2.51 Qianggu capsule plus alendronate versus alendronate (BMD of Ward's, 6 months)
180Mean Difference (IV, Random, 95% CI)0.05 [0.02, 0.07]

    2.52 Xianlinggubao capsule plus alendronate versus alendronate (BMD of Ward's, 6 months)
1104Mean Difference (IV, Random, 95% CI)0.04 [0.02, 0.06]

    2.53 Gusongbao granule plus compound calcium amino acid chelate capsule versus placebo granule plus compound calcium amino acid chelate capsule (BMD of Ward's, 6 months)
196Mean Difference (IV, Random, 95% CI)-0.01 [-0.06, 0.04]

    2.54 Xianlinggubao capsule plus compound calcium amino acid chelate capsules versus compound calcium amino acid chelate capsules (BMD of Ward's, 6 months)
1106Mean Difference (IV, Random, 95% CI)0.23 [0.19, 0.27]

    2.55 Migu tablet plus compound calcium amino acid chelate capsules versus compound calcium amino acid chelate capsules (BMD of Ward's, 6 months)
1107Mean Difference (IV, Random, 95% CI)0.28 [0.24, 0.32]

    2.56 Jiangu granule plus compound calcium amino acid chelate capsule versus placebo granule plus compound calcium amino acid chelate capsule (BMD of Ward's, 6 months)
196Mean Difference (IV, Random, 95% CI)-0.01 [-0.06, 0.04]

    2.57 Xuduanzhuanggu capsule plus calcium tablet versus placebo plus calcium tablet (BMD of Ward's, 6 months)
1480Mean Difference (IV, Random, 95% CI)0.02 [-0.00, 0.04]

    2.58 Gusongbao granule plus calcium tablet versus placebo plus calcium tablet (BMD of Ward's, 6 months)
1240Mean Difference (IV, Random, 95% CI)0.01 [-0.02, 0.04]

    2.59 Yigu capsule plus calcium versus placebo plus calcium (BMD of Ward's, 6 months)
1140Mean Difference (IV, Random, 95% CI)0.04 [0.00, 0.08]

    2.60 Antai capsule plus Caltrate versus Caltrate (BMD of trochanter, 6 months)
1128Mean Difference (IV, Random, 95% CI)0.03 [0.00, 0.06]

    2.61 Migu tablet plus Caltrate versus Caltrate (BMD of trochanter, 12 months)
144Mean Difference (IV, Random, 95% CI)0.15 [0.14, 0.16]

    2.62 Xuduanzhuanggu capsule plus calcium tablet versus placebo plus calcium tablet (BMD of trochanter, 6 months)
1480Mean Difference (IV, Random, 95% CI)0.0 [-0.02, 0.02]

    2.63 Migu tablet plus compound calcium amino acid chelate capsules versus compound calcium amino acid chelate capsules (BMD of trochanter, 6 months)
1107Mean Difference (IV, Random, 95% CI)0.12 [0.07, 0.17]

    2.64 Xianlinggubao capsule plus compound calcium amino acid chelate capsules versus compound calcium amino acid chelate capsules (BMD of trochanter, 6 months)
1106Mean Difference (IV, Random, 95% CI)0.13 [0.08, 0.18]

    2.65 Gusongbao granule plus calcium tablet versus placebo plus calcium tablet (BMD of trochanter, 6 months)
1240Mean Difference (IV, Random, 95% CI)0.0 [-0.03, 0.03]

    2.66 Yigu capsule plus calcium versus placebo plus calcium (BMD of trochanter, 6 months)
1140Mean Difference (IV, Random, 95% CI)0.02 [-0.02, 0.06]

    2.67 Gushukang granule plus Calcium carbonate with vitamin D chewable tablets versus Calcium carbonate with vitamin D chewable tablets (BMD of hip bone, 6 months)
142Mean Difference (IV, Random, 95% CI)0.15 [0.11, 0.19]

    2.68 Jinwugutong capsules plus calcium versus placebo plus calcium (BMD of hip bone, 6 months)
1120Mean Difference (IV, Random, 95% CI)0.01 [-0.02, 0.04]

    2.69 Gengnian Anyi tablet plus Caltrate versus Caltrate (BMD of distal radius, 6 months)
142Mean Difference (IV, Random, 95% CI)0.01 [-0.06, 0.08]

    2.70 Shangke Yishen Zhuanggu pill plus Caltrate and calcitonin versus Caltrate and calcitonin (BMD of lumbar spine, 3 months)
1300Mean Difference (IV, Random, 95% CI)0.04 [0.03, 0.05]

    2.71 Bushenhuoxue therapy plus calcium carbonate tablets and alfacalcidol versus calcium carbonate tablets and alfacalcidol (BMD of lumbar spine, 3 months)
180Mean Difference (IV, Random, 95% CI)-0.01 [-0.04, 0.02]

    2.72 Gukang tablet plus oyster shell calcium chewable tablets and vitamin A and D capsules versus oyster shell calcium chewable tablets and vitamin A and D capsules (BMD of lumbar spine, for 3 months)
180Mean Difference (IV, Random, 95% CI)0.24 [0.14, 0.34]

    2.73 Liuwei Dihuang pills plus Caltrate versus Caltrate (BMD of lumbar spine, 6 months)
172Mean Difference (IV, Random, 95% CI)0.05 [0.02, 0.08]

    2.74 Yiyuanjiangu decoction plus calcitonin and calcium carbonate tablet versus calcitonin and calcium carbonate tablet (BMD of lumbar spine,3 months)
1120Mean Difference (IV, Random, 95% CI)0.02 [-0.01, 0.05]

    2.75 Yiyuanjiangu decoction plus calcitonin and calcium carbonate tablet versus calcitonin and calcium carbonate tablet (BMD of femoral neck, 3 months)
1120Mean Difference (IV, Random, 95% CI)0.01 [-0.01, 0.03]

    2.76 Yiyuanjiangu decoction plus calcitonin and calcium carbonate tablet versus calcitonin and calcium carbonate tablet (BMD of trochanter, 3 months)
1120Mean Difference (IV, Random, 95% CI)0.02 [0.01, 0.04]

    2.77 Yishen Zhuanggu decoction plus calcitriol soft capsule versus calcitriol soft capsule (BMD of lumbar spine, 3 months)
1100Mean Difference (IV, Random, 95% CI)0.02 [-.00, 0.05]

    2.78 Hugu capsule plus Caltrate versus placebo capsule plus Caltrate (BMD of lumbar spine, 6 months)
1122Mean Difference (IV, Random, 95% CI)0.03 [-0.00, 0.06]

    2.79 Hugu capsule plus Caltrate versus placebo capsule plus Caltrate (BMD of Ward's, 6 months)
1122Mean Difference (IV, Random, 95% CI)0.05 [0.02, 0.08]

    2.80 Bushen Qianggu Huoxue therapy plus calcium and cod liver oil versus calcium and cod liver oil (BMD of lumbar spine, 3 months)
184Mean Difference (IV, Random, 95% CI)0.05 [-0.01, 0.11]

    2.81 Bushen Qianggu Huoxue therapy plus calcium and cod liver oil versus calcium and cod liver oil (BMD of femoral neck, 3 months)
184Mean Difference (IV, Random, 95% CI)0.02 [-0.02, 0.05]

    2.82 Bushen Qianggu Huoxue therapy plus calcium and cod liver oil versus calcium and cod liver oil (BMD of Ward's, 3 months)
184Mean Difference (IV, Random, 95% CI)0.04 [0.02, 0.07]

    2.83 Xianlinggubao capsule (low-dose) plus calcium and vitamin D versus placebo plus calcium and vitamin D (BMD of lumbar spine, 12 months)
1120Mean Difference (IV, Random, 95% CI)0.0 [-0.04, 0.04]

    2.84 Xianlinggubao capsule (high-dose) plus calcium and vitamin D versus placebo plus calcium and vitamin D (BMD of lumbar spine, 12 months)
1116Mean Difference (IV, Random, 95% CI)0.0 [-0.03, 0.03]

    2.85 Xianlinggubao capsule (low-dose) plus calcium and vitamin D versus placebo plus calcium and vitamin D (BMD of femoral neck, 12 months)
1120Mean Difference (IV, Random, 95% CI)-0.01 [-0.05, 0.03]

    2.86 Xianlinggubao capsule (high-dose) plus calcium and vitamin D versus placebo plus calcium and vitamin D (BMD of femoral neck, 12 months)
1116Mean Difference (IV, Random, 95% CI)-0.01 [-0.05, 0.03]

    2.87 Bushen Zhuanggu granules plus calcium and vitamin D versus placebo granules plus calcium and vitamin D (BMD of distal radius, 5 years)
1155Mean Difference (IV, Random, 95% CI)0.10 [0.09, 0.10]

 3 T score in BMD measurement167Mean Difference (IV, Fixed, 95% CI)0.91 [0.57, 1.25]

    3.1 Erxian Yanggu decoction plus alendronate sodium tablets versus alendronate sodium tablets (T score, 6 months)
167Mean Difference (IV, Fixed, 95% CI)0.91 [0.57, 1.25]

 4 Quality of life180Mean Difference (IV, Fixed, 95% CI)5.30 [3.67, 6.93]

    4.1 Bushenhuoxue therapy plus calcium carbonate tablets and alfacalcidol versus calcium carbonate tablets and alfacalcidol (3 months)
180Mean Difference (IV, Fixed, 95% CI)5.30 [3.67, 6.93]

 5 Symptoms including pain, muscle fatigue and limited mobility4Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    5.1 Heche Dazao pill plus oyster shell calcium chewable tablets versus oyster shell calcium chewable tablets (3 months)
1114Risk Ratio (M-H, Fixed, 95% CI)1.15 [1.01, 1.30]

    5.2 Xianlinggubao capsule plus salmon calcitonin and Caltrate versus salmon calcitonin plus Caltrate (3 months)
1107Risk Ratio (M-H, Fixed, 95% CI)1.33 [1.09, 1.61]

    5.3 Zhuangguqiangjin tablet and Shujinbogu tablet plus calcitonin versus calcitonin (12 months)
182Risk Ratio (M-H, Fixed, 95% CI)1.01 [0.91, 1.12]

    5.4 Kanggusong soup plus Caltrate versus Caltrate (3 months)
175Risk Ratio (M-H, Fixed, 95% CI)1.48 [1.09, 2.02]

 6 Oestradiol (E2)9Mean Difference (IV, Random, 95% CI)Subtotals only

    6.1 Gushen decoction plus Caltrate and Alfacalcidol versus Caltrate and Alfacalcidol (6 months)
164Mean Difference (IV, Random, 95% CI)4.54 [0.47, 8.61]

    6.2 Ziyin Bushen Zhuanggu prescription plus Caltrate and Calcitonin versus Caltrate plus Calcitonin (8 months)
145Mean Difference (IV, Random, 95% CI)23.21 [14.46, 31.96]

    6.3 Zhuanggu capsule plus Caltrate versus Caltrate (6 months)
160Mean Difference (IV, Random, 95% CI)4.06 [2.56, 5.56]

    6.4 Bushen Qiangshen pill plus Caltrate versus Caltrate (3 months)
140Mean Difference (IV, Random, 95% CI)7.60 [-0.51, 15.71]

    6.5 Antai capsule plus Caltrate versus Caltrate (6 months)
1128Mean Difference (IV, Random, 95% CI)11.0 [8.14, 13.86]

    6.6 Zishen prescription plus Caltrate and calcitonin versus Caltrate plus calcitonin (8 months)
145Mean Difference (IV, Random, 95% CI)23.21 [14.46, 31.96]

    6.7 Shugan zishen huoxue tang plus Caltrate and alendronate sodium tablets versus Caltrate plus alendronate sodium tablets (6 months)
142Mean Difference (IV, Random, 95% CI)26.99 [18.44, 35.54]

    6.8 Xianlinggubao capsule plus vitamin D3 and calcium amino acid chelate versus vitamin D3 and calcium amino acid chelate (48 weeks)
1112Mean Difference (IV, Random, 95% CI)6.04 [4.61, 7.47]

    6.9 Yigu capsule plus calcium versus placebo plus calcium (6 months)
1140Mean Difference (IV, Random, 95% CI)40.85 [33.61, 48.09]

 7 Serum calcium (Ca)12Mean Difference (IV, Random, 95% CI)Subtotals only

    7.1 Gushen decoction plus Caltrate and Alfacalcidol versus Caltrate and Alfacalcidol (6 months)
164Mean Difference (IV, Random, 95% CI)0.05 [-0.02, 0.12]

    7.2 Gushukang granule plus Calcium carbonate with vitamin D chewable tablets versus Calcium carbonate with vitamin D chewable tablets (6 months)
142Mean Difference (IV, Random, 95% CI)-0.01 [-0.09, 0.07]

    7.3 Zhuanggu capsule plus Caltrate versus Caltrate (6 months)
160Mean Difference (IV, Random, 95% CI)0.01 [-0.07, 0.09]

    7.4 Antai capsule plus Caltrate versus Caltrate (6 months)
1128Mean Difference (IV, Random, 95% CI)-0.03 [-0.09, 0.03]

    7.5 Jinwugutong capsules plus calcium versus placebo plus calcium (6 months)
1120Mean Difference (IV, Random, 95% CI)-0.05 [-0.11, 0.01]

    7.6 Xianlinggubao capsule plus salmon calcitonin and Caltrate versus salmon calcitonin plus Caltrate (3 months)
1107Mean Difference (IV, Random, 95% CI)0.03 [-0.09, 0.15]

    7.7 Bushenyiqihuoxue soup plus tamoxifen and Caltrate versus tamoxifen and Caltrate (3 months)
1120Mean Difference (IV, Random, 95% CI)0.37 [0.32, 0.42]

    7.8 Yigu capsule plus calcium versus placebo plus calcium (6 months)
1140Mean Difference (IV, Random, 95% CI)-0.07 [-0.13, -0.01]

    7.9 Chinese medicine (combination of 10 herbs) plus tamoxifen and Caltrate versus tamoxifen and Caltrate (3 months)
1120Mean Difference (IV, Random, 95% CI)0.37 [0.32, 0.42]

    7.10 Zhuangguqiangjin tablet and Shujinbogu tablet plus calcitonin versus calcitonin (12 months)
190Mean Difference (IV, Random, 95% CI)-0.02 [-0.10, 0.06]

    7.11 Huangqi plus Caltrate versus Caltrate (6 months)
136Mean Difference (IV, Random, 95% CI)0.28 [0.11, 0.45]

    7.12 Yiyuanjiangu decoction plus calcitonin and calcium carbonate tablet versus calcitonin and calcium carbonate tablet (3 months)
1120Mean Difference (IV, Random, 95% CI)-0.02 [-0.06, 0.02]

 8 Phosphorus (P)10Mean Difference (IV, Fixed, 95% CI)Subtotals only

    8.1 Gushen decoction plus Caltrate and Alfacalcidol versus Caltrate and Alfacalcidol (6 months)
164Mean Difference (IV, Fixed, 95% CI)-0.13 [-0.27, 0.01]

    8.2 Gushukang granule plus Calcium carbonate with vitamin D chewable tabletsl versus Calcium carbonate with vitamin D chewable tablets (6 months)
142Mean Difference (IV, Fixed, 95% CI)-0.02 [-0.11, 0.07]

    8.3 Zhuanggu capsule plus Caltrate versus Caltrate (6 months)
160Mean Difference (IV, Fixed, 95% CI)0.01 [-0.06, 0.08]

    8.4 Antai capsule plus Caltrate versus Caltrate (6 months)
1128Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.23, 0.21]

    8.5 Jinwugutong capsules plus calcium versus placebo plus calcium (6 months)
1120Mean Difference (IV, Fixed, 95% CI)-0.02 [-0.09, 0.05]

    8.6 Xianlinggubao capsule plus salmon calcitonin and Caltrate versus salmon calcitonin plus Caltrate (3 months)
1107Mean Difference (IV, Fixed, 95% CI)0.01 [-0.12, 0.14]

    8.7 Yigu capsule plus calcium versus placebo plus calcium (6 months)
1140Mean Difference (IV, Fixed, 95% CI)-0.03 [-0.08, 0.02]

    8.8 Zhuangguqiangjin tablet and Shujinbogu tablet plus calcitonin versus calcitonin (12 months)
190Mean Difference (IV, Fixed, 95% CI)-0.02 [-0.08, 0.04]

    8.9 Huangqi plus Caltrate versus Caltrate (6 months)
136Mean Difference (IV, Fixed, 95% CI)0.31 [0.14, 0.48]

    8.10 Yiyuanjiangu decoction plus calcitonin and calcium carbonate tablet versus calcitonin and calcium carbonate tablet (3 months)
1120Mean Difference (IV, Fixed, 95% CI)0.06 [-0.22, 0.34]

 9 Alkaline phosphatase (ALP)15Mean Difference (IV, Fixed, 95% CI)Subtotals only

    9.1 Gushukang granule plus Calcium carbonate with vitamin D chewable tablets versus Calcium carbonate with vitamin D chewable tablets (6 months)
139Mean Difference (IV, Fixed, 95% CI)-0.5 [-1.70, 0.70]

    9.2 Zhuanggu capsule plus Caltrate versus Caltrate (6 months)
160Mean Difference (IV, Fixed, 95% CI)0.0 [-1.55, 1.55]

    9.3 Bushen Qiangshen pill plus Caltrate versus Caltrate (3 months)
140Mean Difference (IV, Fixed, 95% CI)-0.31 [-1.72, 1.10]

    9.4 Xianlinggubao capsule plus salmon calcitonin and Caltrate versus salmon calcitonin plus Caltrate (3 months)
1107Mean Difference (IV, Fixed, 95% CI)-0.99 [-1.52, -0.46]

    9.5 Antai capsule plus Caltrate versus Caltrate (6 months)
1128Mean Difference (IV, Fixed, 95% CI)1.28 [0.55, 2.01]

    9.6 Traditional Chinese capsule plus calcium gluconate versus calcium gluconate (9 months)
160Mean Difference (IV, Fixed, 95% CI)1.77 [1.20, 2.34]

    9.7 Jinwugutong capsules plus calcium versus placebo plus calcium (6 months)
1120Mean Difference (IV, Fixed, 95% CI)1.01 [-0.04, 2.06]

    9.8 Yigu capsule plus calcium versus placebo plus calcium (6 months)
1140Mean Difference (IV, Fixed, 95% CI)1.73 [0.71, 2.75]

    9.9 Chinese medicine (combination of 10 herbs) plus tamoxifen and Caltrate versus tamoxifen and Caltrate (3 months)
1120Mean Difference (IV, Fixed, 95% CI)-0.26 [-1.64, 1.12]

    9.10 Zhuangguqiangjin tablet and Shujinbogu tablet plus calcitonin versus calcitonin (12 months)
190Mean Difference (IV, Fixed, 95% CI)0.08 [-0.54, 0.70]

    9.11 Bushenyiqihuoxue soup plus tamoxifen and Caltrate versus tamoxifen and Caltrate (3 months)
1120Mean Difference (IV, Fixed, 95% CI)3.54 [1.68, 5.40]

    9.12 Huangqi plus Caltrate versus Caltrate (6 months)
136Mean Difference (IV, Fixed, 95% CI)0.82 [0.63, 1.01]

    9.13 Xianlinggubao capsule plus vitamin D3 and calcium amino acid chelate versus vitamin D3 and calcium amino acid chelate (48 weeks)
1112Mean Difference (IV, Fixed, 95% CI)10.48 [9.81, 11.15]

    9.14 Kanggusong soup plus Caltrate versus Caltrate (3 months)
175Mean Difference (IV, Fixed, 95% CI)-1.61 [-3.17, -0.05]

    9.15 Yiyuanjiangu decoction plus calcitonin and calcium carbonate tablet versus calcitonin and calcium carbonate tablet (3 months)
1120Mean Difference (IV, Fixed, 95% CI)0.31 [-0.48, 1.10]

 10 Bone Gla protein (BGP)8Mean Difference (IV, Fixed, 95% CI)Subtotals only

    10.1 Zhuanggu capsule plus Caltrate versus Caltrate (6 months)
160Mean Difference (IV, Fixed, 95% CI)-2.3 [-4.07, -0.53]

    10.2 Traditional Chinese capsule plus calcium gluconate versus calcium gluconate (9 months)
160Mean Difference (IV, Fixed, 95% CI)1.23 [0.88, 1.58]

    10.3 Xianlinggubao capsule plus salmon calcitonin and Caltrate versus salmon calcitonin plus Caltrate (3 months)
1107Mean Difference (IV, Fixed, 95% CI)0.56 [-0.30, 1.42]

    10.4 Yigu capsule plus calcium versus placebo plus calcium (6 months)
1140Mean Difference (IV, Fixed, 95% CI)2.60 [1.66, 3.54]

    10.5 Xianlinggubao capsule plus vitamin D3 and calcium amino acid chelate versus vitamin D3 and calcium amino acid chelate (48 weeks)
1112Mean Difference (IV, Fixed, 95% CI)6.24 [5.69, 6.79]

    10.6 Xianlinggubao capsule plus Caltrate versus Caltrate (12 months)
168Mean Difference (IV, Fixed, 95% CI)1.85 [0.87, 2.83]

    10.7 Jinwugutong capsules plus calcium versus placebo plus calcium (6 months)
1120Mean Difference (IV, Fixed, 95% CI)2.47 [1.44, 3.50]

    10.8 Huangqi plus Caltrate versus Caltrate (6 months)
136Mean Difference (IV, Fixed, 95% CI)0.63 [0.50, 0.76]

 11 Interleukin-6 (IL-6)3Mean Difference (IV, Fixed, 95% CI)Subtotals only

    11.1 Erxian Yanggu decoction plus alendronate sodium tablets versus alendronate sodium tablets (6 months)
167Mean Difference (IV, Fixed, 95% CI)-16.18 [-19.62, -12.74]

    11.2 Xianlinggubao capsule plus vitamin D3 and calcium amino acid chelate versus vitamin D3 and calcium amino acid chelate (48 weeks)
1112Mean Difference (IV, Fixed, 95% CI)-133.3 [-139.94, -126.66]

    11.3 Kanggusong soup plus Caltrate versus Caltrate (3 months)
175Mean Difference (IV, Fixed, 95% CI)-16.32 [-31.60, -1.04]

 
Summary of findings for the main comparison. Chinese herbal medicines versus placebo for osteoporosis

Chinese herbal medicines versus placebo for osteoporosis

Patient or population: patients with osteoporosis
Settings: inpatients
Intervention: Chinese herbal medicine versus placebo

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

(95% CI)

Assumed riskCorresponding risk

Control (placebo)Chinese herbal medicine

New fractures

(Kanggusong capsule versus placebo)

Follow-up: 12 months
185 per 10000 per 1000
(0 to 157)
RR 0.05
(0 to 0.85)
104
(1 study)
⊕⊝⊝⊝
very low1,2,3
We are uncertain about the estimate3

Quality of lifeSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

DeathSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

Serious adverse eventsSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

BMD of lumbar spine (Kanggusong capsule versus placebo)

Follow-up: 12 months
Scale from: 0 to 4
The mean BMD in the control groups was 0.82 g/cm3 The mean BMD in the intervention groups was 0.06 higher
(0.02 to 0.1 higher)
140
(1 study)
⊕⊕⊝⊝
low1,4
MD 0.06 g/cm3 (0.02 to 0.10)

Absolute risk difference 2% (1% to 3%)

Relative per cent change 7% (2% to 12%)

NNT 5 (3 to 13)

BMD of ulna

(Bushen Yigu soft extract versus placebo)
Follow-up: 3 months
Scale from: 0 to 4
The mean BMD in the control groups was 0.59 g/cm3 The mean BMD in the intervention groups was 0.06 higher (0.02 to 0.1 higher)59
(1 study)
⊕⊕⊝⊝
low1,4
MD 0.06 g/cm3 (0.02 to 0.10)

Absolute risk difference 2% (1% to 3%)

Relative per cent change 10% (3% to 17%)

NNT 3 (2 to 8)

BMD of radius

(Bushen Yigu soft extract versus placebo)

Follow-up: 3 months
Scale from: 0 to 4
The mean BMD in the control groups was 0.58 g/cm3 The mean BMD in the intervention groups was 0.06 higher (0.03 to 0.09 higher)59
(1 study)
⊕⊕⊝⊝
low1,4
MD 0.06 g/cm3 (0.03 to 0.09)

Absolute risk difference 2% (1% to 2%)

Relative per cent change 10% (5% to 16%)

NNT 3 (2 to 6)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
BMD: bone mineral density; CI: confidence interval; MD: mean difference; NNT: number needed to treat; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1No information on adequate sequence generation and not all the outcomes that were of interest in this review were reported.
2The total population size is less than 300 (a threshold rule-of-thumb value).
3Seven trials reported on the outcome of fracture incidence, but these trials were small in sample size, suffered from various biases, tested different Chinese herbal medicines and the results were not consistent.
4The total population size is less than 400 (a threshold rule-of-thumb value).
 
Summary of findings 2. Chinese herbal medicines versus no intervention for osteoporosis

Chinese herbal medicines versus no intervention for osteoporosis

Patient or population: patients with osteoporosis
Settings: inpatients and outpatients
Intervention: Chinese herbal medicine versus no intervention

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

Control (no intervention)Chinese herbal medicine

New fracturesSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

Quality of lifeSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

DeathSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

Serious adverse eventsSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

BMD of lumbar spine
(Bushen Shengsui principle versus no intervention)

Follow-up: 6 months
Scale from: 0 to 4
The mean BMD in the control groups was 0.82 g/cm3 The mean BMD in the intervention groups was 0.07 higher
(0.06 lower to 0.2 higher)
61
(1 study)
⊕⊕⊝⊝
low1,2
MD 0.07 g/cm3 (-0.06 to 0.20)

Absolute risk difference 2% (-2% to 5%)

Relative per cent change 9% (-7% to 24%)

Not statistically significant

BMD of femoral neck

(Shigu yin versus no intervention)

Follow-up: 6 months
Scale from: 0 to 4
The mean BMD in the control groups was 0.60 g/cm3 The mean BMD in the intervention groups was 0.08 higher

(0.03 to 0.13 higher)
80
(1 study)
⊕⊕⊝⊝
low1,2
MD 0.08 g/cm3 (0.03 to 0.13)

Absolute risk difference 2% (1% to 3%)

Relative per cent change 13% (5% to 22%)

NNT 4 (3 to 8)

BMD of femoral neck
(Shengu capsule versus no intervention)

Follow-up: 6 months
Scale from: 0 to 4
The mean BMD in the control groups was 0.62 g/cm3 The mean in the intervention groups was 0.02 higher
(0.06 lower to 0.09 higher)
34
(1 study)
⊕⊕⊝⊝
low1,2
MD 0.02 g/cm3 (-0.06 to 0.09)

Absolute risk difference 1% (-2% to 2%)

Relative per cent change 3% (-10% to 15%)

Not statistically significant

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
BMD: bone mineral density; CI: confidence interval; MD: mean difference; NNT: number needed to treat; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1No information on adequate sequence generation and not all the outcomes that were of interest in this review were reported.
2The total population size is less than 400 (a threshold rule-of-thumb value).
 
Summary of findings 3. Chinese herbal medicines versus western medicine for osteoporosis

Chinese herbal medicines versus western medicine for osteoporosis

Patient or population: patients with osteoporosis
Settings: outpatients and inpatients
Intervention: Chinese herbal medicine versus western medicine

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

Control (western medicine)Chinese herbal medicine

New fractures

(Kanggusong granule versus calcium and vitamin D)

Follow-up: 9 months
0 per 400 per 31Not estimable71
(1 study)
⊕⊕⊝⊝
very low1,2
We are uncertain about the estimate3

Quality of lifeSee commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome

Death See commentSee commentNot estimable0
(0)
See commentNo trial reported this outcome