| Objective To systematically evaluate the efficacy of kidney-tonifying and blood-activating therapy on bone mineral density (BMD) and bone metabolism markers in the treatment of osteoporosis (OP). Methods Chinese databases (CNKI, VIP, and Wanfang) and English databases (PubMed, Embase, Web of Science, and Cochrane) were screened. Randomized controlled trials that used kidney-tonifying and blood-activating therapy in combination with traditional Chinese medicine preparations or conventional therapy to treat BMD and bone metabolism markers in OP were included. The quality of the included literature was evaluated using the modified Jadad rating scale recommended by Cochrane and the risk of bias tool for randomized controlled trials. Meta-statistical analysis was performed using RevMan5.3 software. Results A total of 16 articles including 1851 patients were included. (1) The results of the analysis indicated the following advantages of combining traditional Chinese medicine preparations with conventional therapy for the treatment of OP compared to the control group, including Traditional Chinese Medicine Syndrome Score [MD= -2.99, 95% CI (-4.11~-1.86), P<0.00001], lumbar spine BMD [MD=0.06, 95% CI (0.04-0.08), P<0.00001], femoral neck BMD [MD=0.04, 95% CI (0.03-0.06), P<0.000 01], bone glaprotein (BGP) [MD=1.41, 95% CI (0.68-2.14), P=0.000 1], and type I collagen carboxy terminal peptide β special sequence (β-CTX) [MD=-0.28, 95% CI (-0.42--0.14), P=0.0001]. Additionally, there were no significant differences observed in Wards triangle BMD after OP, bone specific alkaline phosphatase (BALP), N-terminal propeptide of type I procollagen (PINP), and tartrate-resistant acid phosphatase 5B (TRACP-5B) when compared to those in the control group. (2) Subgroup analysis revealed that the combination of traditional Chinese medicine preparations with conventional therapy was significantly more effective than the control group in treating lumbar spine BMD and BGP for all three types of OP. Additionally, it demonstrated greater efficacy in treating senile osteoporosis (SOP) and primary osteoporosis (POP) than in postmenopausal osteoporosis (PMOP) in terms of BGP. Conclusions (1) In the treatment of osteoporosis, the combination of traditional Chinese medicine preparations using the method of tonifying the kidney and promoting blood circulation, along with conventional therapy, has shown more significant efficacy in terms of traditional Chinese medicine syndrome differentiation, bone mineral density (lumbar spine and femoral neck), BGP and β-CTX. (2) Furthermore, the efficacy of traditional Chinese medicine preparations that tonify the kidney and activate blood circulation, in combination with conventional therapy, is significantly better than that of the control in treating lumbar spine BMD and BGP for all three types of OP. Additionally, it has been found to be more effective in treating SOP and POP compared to PMOP in terms of BGP. (3) Further research should be conducted using unified, standardized, and high-quality large-sample studies to analyze and evaluate these results. |