Efficacy and Safety of Traditional Chinese Medicine in Treating Chronic Obstructive Pulmonary Disease with Osteoporosis: A Systematic Review and Meta-Analysis

Abstract

Abstract This comprehensive meta-analysis on the efficacy and safety of traditional Chinese medicine (TCM) as an adjunctive therapy to conventional treatment of chronic obstructive pulmonary disease (COPD) with osteoporosis (OP) aimed to provide evidence and guidance for clinical practice. We systematically searched four international databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) published up to November 2025. Meta-analysis and sensitivity analysis were performed in R using the meta and gemtc packages. The revised Cochrane risk of bias tool (ROB2) was employed to assess the quality of included studies to ensure their rigor and clinical applicability. A total of 11 eligible studies involving 944 patients were identified. The results indicated that compared with conventional Western medical therapy (CWMT) alone, CWMT plus TCM demonstrated a certain degree of improvement in the primary outcomes, namely bone mineral density (BMD) (standardized mean difference [SMD] = 0.71, 95% confidence interval [CI]: 0.34–1.07, I2 = 83.8%, PHEW < 0.001) and forced expiratory volume in 1 second (FEV1) (SMD = 0.54, 95% CI: 0.17–0.90, I2 = 76.5%, PHEW = 0.007). Statistically significant improvements were observed in some secondary outcomes. The original studies did not adequately report adverse events. The available data only suggested short-term tolerability. According to network meta-analysis results, among the three treatment approaches, the TLKRBS (tonifying the lung and kidney and resolving blood stasis) approach had the highest probability of being ranked first for increasing BMD (surface under the cumulative ranking curve [SUCRA] = 98.82%) and FEV1 (SUCRA = 99.99%), indicating a substantial effect on improvement. The combination of CWMT and TCM may yield more favorable outcomes compared to CWMT alone for treating COPD with OP. The meta-analysis results indicate that the therapeutic efficacy of TCM combined with CWMT may be improved to a certain extent compared with CWMT alone. However, the certainty of the evidence is limited due to small sample sizes, high heterogeneity, and risks of bias. Future high-quality RCTs with rigorous designs, larger sample sizes, and standardized outcome measures are warranted to strengthen the evidence base for the application of TCM in patients with COPD and comorbid OP and to further confirm its efficacy.