The efficacy and safety of combining different commercial Chinese polyherbal preparations with conventional Western drugs in the treatment of diabetic osteoporosis: a network meta-analysis

Abstract

Biomedicine for diabetic osteoporosis (DOP) is often associated with serious side effects, such as osteonecrosis of the jaw and atypical femoral fractures. In contrast, recent clinical studies have highlighted the potential of commercial Chinese polyherbal preparations (CCPPs) as effective alternatives. These studies suggest that CCPPs help increase bone mineral density, relieve pain, regulate bone turnover markers, and lower blood glucose, thereby improving osteoporosis. This study aimed to evaluate the effectiveness of six CCPPs combined with biomedicine for the treatment of DOP. A network meta-analysis (NMA) was used to compare and rank the therapeutic effects of these CCPPs. We conducted a comprehensive search of multiple databases up to November 2025 to screen for studies assessing the effectiveness of CCPPs for DOP. Two independent reviewers performed study screening, data extraction, and risk of bias assessment. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2.0, and the certainty of evidence was graded according to the Confidence in Network Meta-Analysis (CINeMA) framework. Continuous outcomes were expressed as mean differences (MD) with 95% confidence intervals (CI); dichotomous outcomes were summarized as odds ratios (OR) or risk ratios (RR) with their corresponding 95% CIs. All analyses were completed using StataMP 18 software, and treatment rankings were determined using the surface under the cumulative ranking curve (SUCRA) method. This study included 34 studies involving 3,720 patients with DOP, evaluating six different CCPP regimens. All CCPP regimens showed benefits in increasing bone mineral density, relieving pain, regulating bone turnover markers, and lowering blood glucose. Compared with biomedicine alone, CCPPs combined with biomedicine demonstrated superior outcomes in overall response rate, bone mineral density, bone turnover markers, alkaline phosphatase reduction, and fasting blood glucose, while also showing a lower incidence of adverse events. Specifically, the Guskang (GSK) regimen ranked highest in overall response rate; Xianling Gubao (XLGB), Jintiange (JTG), and GSK showed notable effects on improving bone mineral density; JTG was best for increasing osteocalcin levels; XLGB ranked highest for calcium and phosphorus; and Liuwei Dihuang Wan (LWDHW) produced the greatest reduction in fasting blood glucose. GL had the lowest incidence of adverse events. Compared with biomedicine alone, combining CCPPs with biomedicine for DOP treatment improves clinical outcomes. However, high-quality, rigorously designed clinical trials are needed to validate these preliminary results. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251240840 , identifier CRD420251240840.