Advertisement

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

Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Chinese herbal medicines Cohort study Osteoporosis Osteoporotic fracture 

Notes

Acknowledgments

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.

References

  1. 1.
    Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jöhnsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Nelson HD, Morris CD, Kraemer DF, Mahon S, Carney N, Nygren PM, Helfand M (2001) Osteoporosis in postmenopausal women: diagnosis and monitoring. Evid Rep Technol Assess 28:1–2Google Scholar
  3. 3.
    International Osteoporosis Foundation. Facts and statistics (2017) https://www.iofbonehealth.org/facts-statistics. Accessed 4 Feb 2017
  4. 4.
    Klop C, Welsing PM, Cooper C, Harvey NC, Elders PJ, Bijlsma JW, Leufkens HG, de Vries F (2014) Mortality in British hip fracture patients, 2000–2010: a population-based retrospective cohort study. Bone 66:171–177PubMedCrossRefGoogle Scholar
  5. 5.
    Schuiling KD, Robinia K, Nye R (2011) Osteoporosis update. J Midwifery Womens Health 56(6):615–627PubMedCrossRefGoogle Scholar
  6. 6.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Kennel KA, Drake MT (2009) Adverse effects of bisphosphonates: implications for osteoporosis management. Mayo Clin Proc 84(7):632–637PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    McGreevy C, Williams D (2011) Safety of drugs used in the treatment of osteoporosis. Ther Adv Drug Saf 2(4):159–172PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    So RWL, Wong HS, Ko KM (2015) A traditional Chinese medicine approach in treating depression by promoting liver qi circulation: a Western medicine perspective. Chin Med 6:187–195CrossRefGoogle Scholar
  10. 10.
    Chen KH, Yeh MH, Livneh H, Chen BC, Lin IH, Lu MC, Tsai TY, Yeh CC (2017) Association of traditional Chinese medicine therapy and the risk of dementia in patients with hypertension: a nationwide population-based cohort study. BMC Complement Altern Med 17:178PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Tsai TY, Livneh H, Hung TH, Lin IH, Lu MC, Yeh CC (2017) Associations between prescribed Chinese herbal medicine and risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide population-based cohort study. BMJ Open 7(1):e014571PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Tsai TY, Li CY, Livneh H, Lin IH, Lu MC, Yeh CC (2016) Decreased risk of stroke in patients receiving traditional Chinese medicine for vertigo: a population-based cohort study. J Ethnopharmacol 184:138–143PubMedCrossRefGoogle Scholar
  13. 13.
    Chung VC, Wu X, Lu P, Hui EP, Zhang Y, Zhang AL, Ay L, Zhao J, Fan M, Ziea ET, Ng BF, Wong SY, Wu JC (2016) Chinese herbal medicine for symptom management in cancer palliative care: systematic review and meta-analysis. Medicine (Baltimore) 95(7):e2793CrossRefGoogle Scholar
  14. 14.
    Ren YB, Huang JH, Cai WJ, Shen ZY (2015) Shen-Jing as a Chinese medicine concept might be a counterpart of stem cells in regenerative medicine. Chin J Integr Med Epub ahead printGoogle Scholar
  15. 15.
    Shu B, Shi Q, Wang YJ (2015) Shen (kidney)-tonifying principle for primary osteoporosis: to treat both the disease and the Chinese medicine syndrome. Chin J Integr Med 21:656–661PubMedCrossRefGoogle Scholar
  16. 16.
    Choi JH, Han Y, Kim YA, Jin SW, Lee GH, Jeong HM, Lee HS, Chung YC, Lee YC, Kim EJ, Lee KY, Jeong HG (2017) Platycodin D inhibits osteoclastogenesis by repressing the NFATc1 and MAPK signaling pathway. J Cell Biochem 118(4):860–868PubMedCrossRefGoogle Scholar
  17. 17.
    Liu Y, Liu JP, Xia Y (2014) Chinese herbal medicines for treating osteoporosis. Cochrane Database Syst Rev 3:CD005467Google Scholar
  18. 18.
    National Health Institute. LHID 2000 (2001). https://nhird.nhri.org.tw/date_03.html. Accessed 9 Nov 2017Google Scholar
  19. 19.
    Feldstein AC, Nichols GA, Elmer PJ, Smith DH, Aickin M, Herson M (2003) Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment. J Bone Joint Surg Am 85-A(12):2294–2302PubMedCrossRefGoogle Scholar
  20. 20.
    Lin TK, Liou YS, Lin CH, Chou P, Jong GP (2018) High-potency statins but not all statins decrease the risk of new-onset osteoporotic fractures: a nationwide population-based longitudinal cohort study. Clin Epidemiol 10:159–165PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, Liang KY (2006) Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag 4(1):1–22Google Scholar
  22. 22.
    Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619PubMedCrossRefGoogle Scholar
  23. 23.
    Wang ZQ, Li JL, Sun YL, Yao M, Gao J, Yang Z, Shi Q, Cui XJ, Wang YJ (2013) Chinese herbal medicine for osteoporosis: a systematic review of randomized controlled trails. Evid Based Complement Alternat Med 2013:356260PubMedPubMedCentralGoogle Scholar
  24. 24.
    Che CT, Wong MS, Lam CW (2016) Natural products from Chinese medicines with potential benefits to bone health. Molecules 21(3):239PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Shih CC, Liao CC, Su YC, Tsai CC, Lin JG (2012) Gender differences in traditional Chinese medicine use among adults in Taiwan. PLoS One 7(4):e32540PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Wang JY, Chen WM, Wen CS, Hung SC, Chen PW, Chiu JH (2017) Du-Huo-Ji-Sheng-Tang and its active component Ligusticum chuanxiong promote osteogenic differentiation and decrease the aging process of human mesenchymal stem cells. J Ethnopharmacol 198:64–72PubMedCrossRefGoogle Scholar
  27. 27.
    Lee SC, Wu SH, Hsiao TH, Yang YC, Tien YC (2005) Effects of Chia-wei-hsiao-yao-san on bone loss in ovariectomized rats. J Food Drug Anal 13(3):232–238Google Scholar
  28. 28.
    Lai JN, Hwang JS, Chen JH, Wang JD (2005) Finished herbal product as an alternative treatment for menopausal symptoms in climacteric women. J Altern Complement Med 11(6):1075–1084.  https://doi.org/10.1089/acm.2005.11.1075 PubMedCrossRefGoogle Scholar
  29. 29.
    Yuan SY, Sheng T, Liu LQ, Zhang YL, Liu XM, Ma T, Zheng H, Yan Y, Ishimi Y, Wang XX (2016) Puerarin prevents bone loss in ovariectomized mice and inhibits osteoclast formation in vitro. Chin J Nat Med 14(4):265–269PubMedGoogle Scholar
  30. 30.
    Ok HM, Gebreamanuel MR, Oh SA, Jeon H, Lee WJ, Kwon O (2015) A root-based combination supplement containing Pueraria lobata and Rehmannia glutinosa and exercise preserve bone mass in ovariectomized rats fed a high-fat diet. Calcif Tissue Int 97(6):624–633PubMedCrossRefGoogle Scholar
  31. 31.
    Ji M, Liu Y, Yang S, Zhai D, Zhang D, Bai L, Wang Z, Yu J, Yu C, Cai Z (2013) Puerarin suppresses proliferation of endometriotic stromal cells in part via differential recruitment of nuclear receptor coregulators to estrogen receptor-α. J Steroid Biochem Mol Biol 138:421–426PubMedCrossRefGoogle Scholar
  32. 32.
    Chen G, Jia P, Gao X (2012) Effect and mechanism of shao-yao gan-cao tang on adjuvant-induced arthritis in rats. Afr J Pharm Pharmacol 6(22):1611–1616Google Scholar
  33. 33.
    Barksby HE, Lea SR, Preshaw PM, Taylor JJ (2007) The expanding family of interleukin-1 cytokines and their role in destructive inflammatory disorders. Clin Exp Immunol 149(2):217–225PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Mukudai Y, Kondo S, Koyama T, Li C, Banka S, Kogure A, Yazawa K, Shintani S (2014) Potential anti-osteoporotic effects of herbal extracts on osteoclasts, osteoblasts and chondrocytes in vitro. BMC Complement Altern Med 14:29PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Kum CJ, Kim EY, Kim JH, Lee B, Min JH, Heo J, Kim JH, Yeom M, Sohn Y, Jung HS (2017) Cyperus rotundus L extract suppresses RANKL-induced osteoclastogenesis through NFATc1/c-fos downregulation and prevent bone loss in OVX-induced osteoporosis rat. J Ethnopharmacol 205:186–194PubMedCrossRefGoogle Scholar
  36. 36.
    Guo AJ, Choi RC, Cheung AW, Chen VP, Xu SL, Dong TT, Chen JJ, Tsim KW (2011) Baicalin, a flavone, induces the differentiation of cultured osteoblasts: an action via the Wnt/beta-catenin signaling pathway. J Biol Chem 286(32):27882–27893PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Liu Y, Uy J, Bai J, Gu JS, Cai B, Zhou X (2013) Effects of cuttlefish bone–bone morphogenetic protein composite material on osteogenesis and revascularization of bone defect in rats. Zhonghua Shao Shang Za Zhi 29(6):548–553PubMedGoogle Scholar
  38. 38.
    Cozza N, Monte F, Bonani W, Aswath P, Motta A, Migliaresi C (2018) Bioactivity and mineralization of natural hydroxyapatite from cuttlefish bone and bioglass co-sintered bioceramics. J Tissue Eng Regen Med 12(2):e113–e1142CrossRefGoogle Scholar
  39. 39.
    Lai MN, Wang SM, Chen PC, Chen YY, Wang JD (2010) Population-based case-control study of Chinese herbal products containing aristolochic acid and urinary tract cancer risk. J Natl Cancer Inst 102(3):179–186PubMedPubMedCentralCrossRefGoogle Scholar

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

Personalised recommendations