| Background: Diabetic osteoporosis is a slowly developing metabolic bone disease characterized by low bone quality and bone microstructure destruction,often accompanied by increased bone absorption and decreased bone formation,and clinically manifested as increased bone fragility and easy fracture.Commonly used drugs such as bisphosphonates have limitations on the use of drug holidays and adverse reactions.The application of tonifying spleen and kidney in the prevention and treatment of diabetic osteoporosis has potential clinical advantages,but there is no evidence based on evidence-based medicine,and its mechanism remains to be explored.Objective: The study first evaluated the efficacy and safety of tonifying spleen and kidney therapy in the treatment of diabetic osteoporosis by meta-analysis,and then studied the effect of spleen-tonifying kidney therapy on the microstructure and morphology of femur bone in diabetic rats by micro-CT method,providing a scientific basis for the prevention and treatment of diabetic osteoporosis by traditional Chinese medicine.Methods:1 A meta-analysis was conducted to evaluate the efficacy and safety of spleen and kidney tonifying therapy in the treatment of diabetic osteoporosis.2 Study on bone microstructure characteristics of diabetic rats by invigorating spleen and kidney2.1 SPF male 8-week-old SD rats were randomly divided into normal control group(n =20)and model group(n = 60)after 1-week adaptive feeding.The normal control group was fed with ordinary feed,and the model group was fed with high fat and high sugar feed.2.2 After 4 weeks of feeding,the rats in the model group were injected intraperitoneally with 1%STZ solution(40mg/kg),and the normal control group was given the same amount of citrate buffer.After 72 hours,blood samples were taken from the tail vein to measure the random blood glucose value ≥16.7mmol/L,indicating that the diabetes model was successfully constructed.2.3 After successful model building,the model group was randomly divided into model group,thirloxin group and spleen tonifying and kidney tonifying group.Normal control group and model group were given 10ml/kg normal saline once a day,thirloxin group was given thirloxin suspension 12ml/kg once a day,bupi yishen decoction suspension13.34ml/kg once a day.2.4 6weeks after intervention in each group randomly take four gather the left femur,using micro computer tomography(micro-CT)test sample of bone microstructure,after the scan is complete,choose proximal femoral neck swelled regions as interested area(ROI),set up three-dimensional reconstruction after the threshold of each specimen ROI line reconstruction,use of airborne software,combining with the analysis of medical statistics.Twelve weeks after intervention,the other experimental models were used the same sampling and experimental methods.Results:1 A total of 10 RCT studies were included in the study.Compared with the control group,the treatment effective rate,TCM syndrome score,bone mineral density,fasting blood glucose,2 hours postprandial blood glucose and hba1 c in the experimental group were statistically significant.There was no statistical difference in blood calcium,blood phosphorus and alkaline phosphatase.2 After 12 weeks of intervention,the total bone mineral density,bone surface area,bone surface area tissue mass ratio,bone surface area bone mass ratio,bone trabecular bone mineral density and bone cortical bone mineral density of femur in spleen-tonification and kidney tonification group were better than those in the model group.There were significant differences in BMD,BS,BS/TV,BS/BV,Tb.BMD and CMD between spleen tonification and kidney tonification group and model group(P=0.015,P=0.043,P=0.039,P=0.002,P=0.041,P=0.009).There was no statistical significance at 6 weeks of intervention(P > 0.05).According to the results of micro-CT 3D reconstruction,compared with the 6-week samples,the trabecular bone in the proximal femoral neck of the model group was sparse in number and larger in gap,and the integrity of the trabecular bone structure was damaged,showing a progressive trend of rod-like structure,with thin cortical bone and uneven edge.However,in the spleen-tonifying and kidney-tonifying group at 12 weeks,there were more trabeculae in the proximal femoral neck,degeneration was slowed down,and cortical bones were thicker and clearer than those in the model group.Conclusion: The treatment of diabetic osteoporosis by tonifying spleen and kidney is safe and effective;The spleen and kidney tonifying method can positively affect the bone microstructure and morphology of diabetic rats.To some extent,tonifying spleen and tonifying kidney can balance broken bone and prevent strabecular structure in rats. |
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