Osteoporosis International

, Volume 30, Issue 4, pp 807–815 | Cite as

Association of use of Chinese herbal medicines and the risk of fracture in patients with osteoporosis: a population-based cohort study

  • W.-J. Chen
  • H. Livneh
  • M.-H. Hsieh
  • C.-C. Yeh
  • M.-H. Yeh
  • M.-C. Lu
  • J.-T. ChienEmail author
  • T.-Y. TsaiEmail author
Original Article



After utilizing a large population-based claims database and the application of propensity score match approach to reduce the confounding effects, we found that the use of Chinese herbal medicines (CHMs) was related to the lower risk of sequent osteoporotic fracture by 27% among the individuals with osteoporosis. The predominant effect was observed in those receiving CHMs for more than two years.


Osteoporosis (OS) is a highly disabling condition that can lead to fragility fracture, thus posing greater burdens of functional limitations for the affected individuals. It is unclear if the use of Chinese herbal medicines (CHMs) could reduce the risk of fracture due to OS. This study aimed to investigate the association of CHMs and the subsequent osteoporotic fracture risk among OS patients.


This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 250,699 newly diagnosed OS patients aged 20 years or older between 1998 and 2010. We recruited 103,325 CHM users following the onset of OS (CHM users) and randomly selected 103,325 subjects without CHM usage as controls (non-CHM users) by propensity score matching according to the demographic characteristics and comorbidities at enrollment. All enrollees were followed until the end of 2012 to record the incidence of osteoporotic fracture. We applied the Cox proportional hazard regression model to compute the hazard ratio (HR) of the risk of osteoporotic fracture.


During the 15-year follow-up period, 7208 CHM users and 11,453 non-CHM users sustained osteoporotic fracture, with an incidence rate of 9.26 and 12.96, respectively, per 1000 person-years. We found that CHM users had a significantly reduced risk of osteoporotic fracture compared to non-CHM users (adjusted HR 0.73; 95% confidence interval [CI] = 0.70–0.75). Those treated with CHMs for longer than 730 days had a lower fracture risk by 54%. Some commonly used CHMs, such as Yan hu suo (Rhizoma Corydalis), Huang Qin (Scutellaria Baicale), Jie Geng (Platycodon grandifloras), Xiang Fu (Cyperus rotundus), Hai Piao Xiao (Cuttlebone Sepium), Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, and Du-Huo-Ji-Sheng-Tang, are related to the lower risk of fracture.


The use of CHMs was associated with lower risk of osteoporotic fracture for OS patients, suggesting that it could be integrated into conventional therapy to prevent subsequent bone fracture.


Chinese herbal medicines Cohort study Osteoporosis Osteoporotic fracture 



This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes. This research was supported by the Dalin Tzuchi Hospital (Grant DTCRD101-E-08).

Compliance with ethical standards

Conflicts of interest

Chen WJ, Livneh H, Hsieh MH, Yeh CC, Yeh MH, Lu MC, Chien JT, and Tsai TY declare that they have no conflict of interest.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • W.-J. Chen
    • 1
  • H. Livneh
    • 2
  • M.-H. Hsieh
    • 3
  • C.-C. Yeh
    • 1
    • 4
    • 5
  • M.-H. Yeh
    • 1
    • 4
    • 5
  • M.-C. Lu
    • 6
    • 7
  • J.-T. Chien
    • 3
    • 6
    Email author
  • T.-Y. Tsai
    • 8
    • 9
    • 10
    Email author
  1. 1.Department of Chinese MedicineDalin Tzuchi Hospital, The Buddhist Tzuchi Medical FoundationChiayiTaiwan
  2. 2.Rehabilitation Counseling ProgramPortland State UniversityPortlandUSA
  3. 3.Department of Orthopedics and Center of OsteoporosisDalin Tzuchi Hospital, The Buddhist Tzuchi Medical FoundationChiayiTaiwan
  4. 4.School of Post-Baccalaureate Chinese MedicineTzu Chi UniversityHualienTaiwan
  5. 5.School of Chinese MedicineChina Medical UniversityTaichungTaiwan
  6. 6.School of MedicineTzu Chi UniversityHualienTaiwan
  7. 7.Division of Allergy, Immunology and RheumatologyDalin Tzuchi Hospital, The Buddhist Tzuchi Medical FoundationChiayiTaiwan
  8. 8.Department of Medical ResearchDalin Tzuchi Hospital, The Buddhist Tzuchi Medical FoundationChiayiTaiwan
  9. 9.Department of Environmental and Occupational Health, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  10. 10.Department of NursingTzu Chi University of Science and TechnologyHualienTaiwan

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