Prevention And Treatment Of Endocrine Therapy-Related Osteoporosis In Breast Cancer With Traditional Chinese Medicine Compound:A Systematic Evaluation And Meta-Analysis

Objective;Through systematic evaluation and Meta analysis to evaluate the clinical efficacy of traditional Chinese medicine(TCM)in preventing and treating endocrine therapy-related osteoporosis of breast cancer,and to provide sufficient reference basis for medical evidence-based selection of TCM prescriptions to prevent and treat osteoporosis related to endocrine therapy of breast cancer.Methods:The electronic databases were retrieved by computer from its establishment until March 2019.Literature retrieval sources include:China Biomedical Liteurature Database(CBM),China Journal Full-Text Database(CNKI),VIP,Wanfang,MEDLINE,EMBASE,Cochrane Central Register of Controlled trials(CENTRAL)Artificial search of relevant magazines,grey literature,conference papers and contact with research correspondents.According to the inclusion and exclusion criteria,literature screening,literature quality evaluation and data extraction are carried out for the final included literature,and statistical analysis methods of data are determined.Results:A total of 23 literatures were included in the system evaluation.The outcome indicators of meta-analysis were:lumbar vertebrae(L2-4),femoral neck bone mineral density,bone calcitonin(BGP),efficacy evaluation of TCM syndromes and safety evaluation(mainly evaluation of estradiol level).The results of meta-analysis by Revman 5.3 software showed that:1.lumbar vertebrae(L2-4)bone mineral density:the change value of lumbar vertebrae(L2-4)bone mineral density in treatment group was higher than that in control group(MD= 0.07,95%CI:[0.06,0.08],P<0.00001),and the results were stable without obvious publication bias;2.Femoral neck bone mineral density:The change value of femoral neck bone mineral density in treatment group was larger than that in control group(MD=0.09,95%CI:[0.07,0.10],P<0.00001),and the results were stable,and there might be publication bias;3.Osteocalcin(BGP)subgroup:Decoction group:About the change value of osteocalcin,the control group and the treatment group had no statistical significance(SMD=-0.22,95%CI:[-0.47,0.03],P=0.09);Non-decoction:osteocalcin change value treatment group.The results of sensitivity analysis were stable and the publication bias could not be evaluated in the control group(SMD=1.22,95%CI:[0.84,1.60],P<0.00001);4.Therapeutic evaluation of TCM syndromes:The improvement efficiency of TCM syndromes in the treatment group was higher than that in the control group(OR=4.62,95%CI:[2.84,7.51],P<0.00001),and the results were stable without obvious publication bias;5.Safety evaluation:(1)Estradiol:the change value of estradiol in the treatment group was not significantly different from that in the control group(SMD=0.23,95%CI:[-0.01,0.47],P=0.06).The results were less stable and published.Less bias;(2)Adverse reactions:Only one article described the systemic symptoms of traditional Chinese medicine intervention,and the other reports showed no related adverse reactions.Conclusion:1.Chinese herbal compound can significantly improve lumbar vertebral bone mineral density and femoral neck bone mineral density in patients with breast cancer endocrine therapy;2.The influence of Chinese herbal compound on bone metabolism index of patients with breast cancer treated by endocrine therapy is different according to different dosage forms.Chinese herbal decoction can not show the improvement effect on this metabolic index,while non-decoction such as capsule or pill can show the improvement of bone calcium index,but by different dosage forms.The results can only be used as a reference in the study of fewer samples;3.Chinese herbal compound can significantly improve the clinical symptoms of breast cancer patients with endocrine therapy due to bone loss or osteoporosis,and improve the quality of life of patients;4.Chinese herbal compound has no significant effect on the level of estrogen in patients with breast cancer with endocrine therapy,and no estrogen effect,will not antagonize the efficacy of endocrine therapy in patients with breast cancer,and the adverse reactions are small;.the overall safety is better.5.Chinese herbal compound can effectively prevent and treat breast cancer endocrine therapy related osteoporosis,which has important clinical significance and research value.