Effects of Chinese herbal formula Erxian decoction for treating osteoporosis: a systematic review

Figures & data

Table 1 Characteristics of included trials

Study ID	Sample size (EG/CG)	Age(years, mean)	Sex (male/female)	Experimental group	Comparison group	Duration of treatment	Outcome assessment
Wu et al^Citation25	58 (30/28)	EG: 68.65±7.07 CG: 67.91±7.37	NR	EXD (a dose/d, Qd, oral administration)	Caltrate tablets (600 mg, Qd, oral administration)	6 months	BMD (LS, FGT Ca, P, ALP
Zhu and Gu^Citation26	70 (35/35)	EG: 61.2±5.6 CG: 60.4±5.8	Postmenopausal women	EXD (a dose/d, Bid, oral administration) + CG	Salmon Calcitonin (50 IU every day, intramuscular injection)	3 months	BMD (LS ALP, BGP, CT, E2
Gao^Citation27	78 (39/39)	EG: 42.3±5.6 CG: 40.7±4.9	EG: 19/20 CG: 21/18	EXD (a dose/d, oral administration)	Women: Nilestriol (2~4 mg every 2 weeks, oral administration) Men: testosterone propionate (20~25 mg every 2 weeks, intramuscular)	2 months	BMD (LS, FN, WA, FGT
Liu^Citation28	138 (69/69)	56.2±9.3	Postmenopausal women	Modified EXD (a dose/d, oral administration) + CG	Caltrate tablets (600 mg, Qd, oral administration) and calcitriol (0.25 μg, Qd, oral administration)	3 months	BMD (LS, FN Ca, P, ALP, ADR
Jiang et al^Citation29	70 (35/35)	EG: 64.64±8.73 CG: 69.41±5.21	Postmenopausal women	Modified EXD (a dose/d, oral administration) + CG	Caltrate tablets (600 mg, Qd, oral administration) and calcitriol (0.25 μg, Bid, oral administration)	3 months	BMD (LS, FN Ca, P, ALP, ADR
Liu^Citation30	70 (35/35)	EG: 42.5±5.1 CG: 43.6±5.4	EG: 15/20 CG: 16/19	Modified EXD (a dose/d, Bid, oral administration)	Caltrate tablets (600 mg, Qd, oral administration)	2 months	BMD (LS, FN, WA, FGT VAS score Ca, P, ALP
Xu et al^Citation31	80 (40/40)	EG: 63.19±5.13 CG: 64.32±6.34	Postmenopausal women	Modified EXD (a dose/d, oral administration) + CG	Caltrate tablets (600 mg, Qd, oral administration), Vitamin D (125 IU, Qd, oral administration) and Alfacalcidol (0.25 μg, Qd, oral administration)	3 months	BMD (FN ALP, E2
Ye et al^Citation32	80 (40/40)	EG: 48.40±7.58 CG: 47.10±3.11	Postmenopausal women	EXD (a dose/d, Bid, oral administration) + CG	Elcatonin (10 IU per time, twice a week, intramuscular injection)	3 months	BMD (LS, tibia VAS score, ADR

Abbreviations: EG, experimental group; CG, comparison group; NR, not reported; EXD, Erxian decoction; LS, lumbar spine; FN, femoral neck; WA, Ward’s area; FGT, femoral great trochanter; BMD, bone mineral density; Ca, calcium; P, phosphorus; CT, calcitonin; E₂, estradiol; ADR, adverse drug reaction; VAS, visual analog scale; ALP, alkaline phosphatase; BGP, bone gla protein.

Figure 1 Study selection process. Databases were PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang databases.

Table 2 Composition of formula

Study ID	Formula	Composition of formula
Wu et al^Citation25	EXD	NR
Zhu and Gu^Citation26	EXD	Epimedii Folium (Yinyanghuo) 20 g, Curculiginis Rhizoma (Xianmao) 20 g, Morindae Officinalis Radix (Bajitian) 15 g, Anemarrhenae Rhizoma (Zhimu) 12 g, Phellodendri Chinensis Cortex (Huangbai) 15 g, Angelicae Sinensis Radix (Danggui) 10 g
Gao^Citation27	EXD	Epimedii Folium (Yinyanghuo) 30 g, Curculiginis Rhizoma (Xianmao) 30 g, Morindae Officinalis Radix (Bajitian) 15 g, Anemarrhenae Rhizoma (Zhimu) 10 g, Phellodendri Chinensis Cortex (Huangbai) 10 g, Angelicae Sinensis Radix (Danggui) 10 g
Liu^Citation28	Modified EXD	Epimedii Folium (Yinyanghuo) 15 g, Curculiginis Rhizoma (Xianmao) 15 g, Morindae Officinalis Radix (Bajitian) 15 g, Anemarrhenae Rhizoma (Zhimu) 10 g, Angelicae Sinensis Radix (Danggui) 10 g, Testudinis Carapacis Et Plastri Colla (Guijiajiao) 12 g, Corni Fructus (Shanzhuyu) 12 g, Lycii Fructus (Gouqi) 12 g, Salviae Miltiorrhizae Radix Et Rhizoma (Danshen) 15 g
Jiang et al^Citation29	Modified EXD	Epimedii Folium (Yinyanghuo) 15 g, Curculiginis Rhizoma (Xianmao) 15 g, Morindae Officinalis Radix (Bajitian) 10 g, Anemarrhenae Rhizoma (Zhimu) 15 g, Phellodendri Chinensis Cortex (Huangbai) 10 g, Angelicae Sinensis Radix (Danggui) 15 g, Pyritum (Zirantong) 10 g
Liu^Citation30	Modified EXD	Epimedii Folium (Yinyanghuo) 15 g, Curculiginis Rhizoma (Xianmao) 10 g, Morindae Officinalis Radix (Bajitian) 15 g, Anemarrhenae Rhizoma (Zhimu) 15 g, Phellodendri Chinensis Cortex (Huangbai) 10 g, Angelicae Sinensis Radix (Danggui) 5 g, Corni Fructus (Shanzhuyu) 10 g, Rehmanniae Radix Praeparata (Shudihuang) 30 g, Dioscoreae Rhizoma (Shanyao) 15 g, Drynariae Rhizoma (Gusuibu) 15 g, Cyathulae Radix (Chuanniuxi) 10 g, Glycyrrhizae Radix Et Rhizoma (Gancao) 3 g, Jujubae Fructus (Dazao) 30 g
Xu et al^Citation31	Modified EXD	Epimedii Folium (Yinyanghuo) 20 g, Curculiginis Rhizoma (Xianmao) 20 g, Morindae Officinalis Radix (Bajitian) 20 g, Anemarrhenae Rhizoma (Zhimu) 15 g, Phellodendri Chinensis Cortex (Huangbai) 10 g, Angelicae Sinensis Radix (Danggui) 15 g, Testudinis Carapacis Et Plastri Colla (Guijiajiao) 10 g, Corni Fructus (Shanzhuyu) 10 g, Lycii Fructus (Gouqi) 10 g, Salviae Miltiorrhizae Radix Et Rhizoma (Danshen) 10 g
Zhu and Gu^Citation32	EXD	Epimedii Folium (Yinyanghuo) 15 g, Curculiginis Rhizoma (Xianmao) 15 g, Morindae Officinalis Radix (Bajitian) 10 g, Anemarrhenae Rhizoma (Zhimu) 6 g, Phellodendri Chinensis Cortex (Huangbai) 6 g, Angelicae Sinensis Radix (Danggui) 10 g

Abbreviations: EXD, Erxian decoction; NR, not reported.

Table 3 Methodological quality of the included trials

Study ID	Random sequence generation	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment	Incomplete outcome data	Selective reporting	Other bias
Wu et al^Citation25	−	?	−	?	?	?	?
Zhu and Gu^Citation26	+	?	−	?	?	?	+
Gao^Citation27	−	?	−	?	?	?	+
Liu^Citation28	−	?	−	?	?	?	?
Jiang et al^Citation29	+	?	−	?	?	?	?
Liu^Citation30	−	?	−	?	?	?	+
Xu et al^Citation31	−	?	−	?	?	?	?
Ye et al^Citation32	+	?	−	?	?	?	+

Notes: “+”, low risk of bias; “−”, high risk of bias; “?”, unclear risk of bias.

Figure 2 Forest plot of comparison between EXD and caltrate tablets. The outcome was BMD in lumbar spine.

Abbreviations: EXD, Erxian decoction; BMD, bone mineral density; CI, confidence interval; SD, standard deviation; df, degrees of freedom.

Figure 3 Forest plot of comparison between EXD plus caltrate tablets and calcitriol versus caltrate tablets and calcitriol. The outcome was BMD in lumbar spine.

Abbreviations: EXD, Erxian decoction; BMD, bone mineral density; CI, confidence interval; SD, standard deviation; df, degrees of freedom.

Figure 4 Forest plot of comparison between EXD plus caltrate tablets and calcitriol versus caltrate tablets and calcitriol. The outcome was BMD in femoral neck.

Abbreviations: EXD, Erxian decoction; BMD, bone mineral density; CI, confidence interval; SD, standard deviation; df, degrees of freedom.

Figure 5 Forest plot of comparison between EXD and caltrate tablets. The outcome was BMD in femoral great trochanter.

Abbreviations: EXD, Erxian decoction; BMD, bone mineral density; CI, confidence interval; SD, standard deviation; df, degrees of freedom.

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