Use of Chinese Herbal Medicine Was Related to Lower Risk of Osteoporotic Fracture in Sarcopenia Patients: Evidence from Population-Based Health Claims

Abstract

Introduction

With population aging, sarcopenia and its accompanying risk of osteoporotic fracture has drawn increased attention. Nowadays, while Chinese herbal medicine (CHM) is often used as complementary therapy for many medical conditions, its effect against likelihood of osteoporotic fracture among sarcopenia subjects was not fully elucidated yet. We therefore conducted a population-level study to compare osteoporotic fracture risk for sarcopenia persons with or without CHM use.

Methods

Using the patient record from a nationwide insurance database, we recruited persons with newly diagnosed sarcopenia and simultaneously free of osteoporotic fracture between 2000 and 2010. Propensity score matching was then applied to randomly select sets of CHM users and non-CHM users. All of them were tracked until end of 2013 to measure the incidence and adjusted hazard ratios (HRs) for new new-onset fracture in multivariable Cox proportional hazards model.

Results

Compared to non-CHM users, the CHM users indeed had a lower incidence of osteoporotic fracture (121.22 vs 156.61 per 1000 person-years). Use of CHM correlated significantly with a lower fracture likelihood after adjusting for potential covariates, and those receiving CHM treatment for more than two years experienced a remarkably lower risk by 73%. Uses of several herbal formulae were correlated to reduced risk of osteoporotic fracture, such as Caulis Spatholobi, Xuduan, Duzhong, Danshen, Shu-Jing-Huo-Xue-Tang, Du-Huo-Ji-Sheng-Tang, Shao-Yao-Gan-Cao-Tang, and Shen-Tong-Zhu-Yu -Tang.

Conclusion

Our study depicted that cumulative CHM exposure was inversely associated with osteoporotic fracture risk in a duration-dependent manner, implying that CHM treatment may be embraced as routine care in preventing incident osteoporotic fracture.

Keywords:

• sarcopenia
• osteoporotic fracture
• risk
• Chinese herbal medicines
• cohort study

Abbreviations

CHM, Chinese herbal medicine; HRs, hazard ratios; IL, interleukin; TNF-α, tumor necrosis factor-α; NF-kB, nuclear factor-kappaB; RANKL, receptor activation of nuclear factor-kappaB ligand; NHI, National Health Insurance; LHID, Longitudinal Health Insurance Database; ICD-9-CM, International Classification of Diseases-Ninth Revision-Clinical Modification; PY, person-years; NTD, New Taiwan Dollars; CCI, Charlson–Deyo comorbidity index; SD, standard deviation; CI, confidence interval; SJHXT, Shu-Jing-Huo-Xue-Tang; DHJST, Du-Huo-Ji-Sheng-Tang; SYGCT, Shao-Yao-Gan-Cao-Tang; STZYT, Shen-Tong-Zhu-Yu –Tang.

Acknowledgments

This study uses 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, Taiwan. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.

Author Contributions

All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work. WJC, HL, HHL and YHW contributed equally to this work.

Disclosure

The authors declare that they have no conflicting interests.

Additional information

Funding

This project was supported by the Tzu Chi Medical Foundation (TCMF-CM2-111-07).