Effectiveness of electroacupuncture as a treatment for osteoporosis: A systematic review and meta-analysis

Electroacupuncture for juvenile idiopathic arthritis: clinical efficacy and its role in modulating pyroptosis and autophagy pathways

BACKGROUND

Juvenile idiopathic arthritis (JIA) is a common chronic inflammatory disorder in children, leading to significant physical and psychosocial challenges. Current treatments often fall short, prompting interest in complementary therapies. This study aims to evaluate the effectiveness of electroacupuncture (EA) on clinical outcomes in children with JIA, focusing on its impact on the pyroptosis pathway and autophagy function.

METHODS

A randomized controlled clinical trial was conducted from 7 November 2023 to 12 January 2025. A total of 106 participants were recruited and randomly assigned to receive EA or sham acupuncture (SA) for 8 weeks. Clinical assessments, including functional ability, pain scores, and quality of life, were measured at baseline, week 4, week 8, month 3, and month 6. Serum levels of pyroptosis-related proteins and autophagy markers were analyzed to elucidate the underlying mechanisms.

RESULTS

The EA group showed significant improvements in functional ability and pain scores compared to the SA group at both week 4 and week 8. Notable reductions in serum levels of pyroptosis markers (caspase-1, GSDMD, NLRP3) and pro-inflammatory cytokines (IL-1β, IL-18) were observed in the EA group. Additionally, autophagy markers (LC3, Becline1) significantly decreased after EA treatment, suggesting enhanced autophagic activity.

CONCLUSION

This study demonstrates that electroacupuncture is a safe and effective adjunctive treatment for improving function and reducing pain in children with JIA. The observed biological changes indicate potential anti-inflammatory effects, supporting EA's role in comprehensive JIA management. Future research should explore long-term outcomes and mechanisms for these findings further. Key Points • The study demonstrates that electroacupuncture (EA) significantly improves functional ability and pain scores in children with juvenile idiopathic arthritis (JIA) compared to sham acupuncture. • EA treatment led to notable reductions in serum levels of pyroptosis-related proteins and pro-inflammatory cytokines, indicating its potential role in modulating inflammatory pathways. • The research observed significant changes in autophagy markers post-EA treatment, suggesting that EA may enhance autophagic function in children with JIA. • EA is presented as a safe adjunctive therapy for JIA management, with implications for further research into its long-term effects and underlying mechanisms.

Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Primary osteoporosis (POP) is a common metabolic bone disorder that has a devastating effect on their quality of life in patients. Acupuncture, a traditional Chinese therapy, has been used to treat osteoporosis for over 2000 years. This study aimed to determine the efficacy of acupuncture in treating POP compared to conventional medicine or placebo.

METHODS

We searched for potentially relevant studies in PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang database and ClinicalTrials.gov up to December 20, 2024. Randomized controlled trials investigating treatment of POP for which acupuncture was administered as a stand-alone treatment or combined with conventional medicine compared to conventional medicine or placebo, were included. The outcomes included bone mineral density (BMD), visual analogue scale (VAS) scores, clinical effectiveness rate, estradiol (E2), Oswestry Disability Index (ODI), and levels of serum alkaline phosphatase (ALP). Data were synthesized using a random-effects meta-analysis model, and the observed heterogeneity was investigated using subgroup analyses. Study quality was appraised using the Cochrane RoB 2 tools, and the quality of the aggregated evidence was evaluated using the GRADE guidelines. Publication bias was assessed by funnel plots and validated by Egger's test.

RESULTS

Forty eligible articles with 2654 participants were identified. Compared to the control group, acupuncture effectively increased the BMD (MD 0.04 [0.03-0.06], P < 0.001, I2 = 92%), clinical efficacy (RR 1.24 [1.14-1.34], P < 0.001, I2 = 81%), and levels of E2 (SMD 0.30 [0.09-0.52], P = 0.006, I2 = 0%), and reduced the VAS scores (SMD - 1.79 [- 2.29 to - 1.29], P < 0.001, I2 = 95%). Data on ODI and ALP were insufficient for meta-analysis.

CONCLUSION

The current evidence suggests that the efficacy of acupuncture in improving the symptoms of POP are encouraging for its use in clinical practice as a physical intervention for patients with POP. However, since the included patients were all from China, there was a risk of sample bias, high-quality multicenter studies in different countries or regions should be conducted in the future.

Electroacupuncture ameliorates senile osteoporosis by promoting bone remodeling and regulating autophagy

OBJECTIVES

Osteoporosis is widely regarded as a typical aged-related disease caused by impaired bone remodeling. This research was designed to explore the protective effects of electroacupuncture (EA) on senile osteoporosis in a rat model and investigate the underlying mechanisms.

METHODS

Three-month-old rats were randomly selected as the youth group, and 24-month-old rats were randomly assigned to the elderly and EA groups. Rats in the EA group received 30 min of EA at bilateral SP10, ST36, K13 and GB34 daily, 5 days a week for 8 weeks. Bone mineral density (BMD), microstructure of the bone tissue, bone turnover biomarkers and expression level of autophagy-related proteins were detected.

RESULTS

Compared with the elderly group, EA treatment significantly increased BMD of the femur and ameliorated the microstructure. EA treatment increased trabecular bone volume ratio (= bone volume / total volume [BV/TV]) and trabecular number (Tb.N) and decreased trabecular separation (Tb.Sp) in senile osteoporosis rats. Compared with the elderly group, the serum N-terminal telopeptide of type I collagen (NTX1) level in the EA group was lower, and the serum procollagen type I N-terminal propeptide (PINP) concentration was higher. In addition, the expression of Beclin 1, microtubule-associated protein I light chain 3 (LC3B) and P62 was inhibited in the senile osteoporosis rats after EA treatment.

CONCLUSIONS

EA can effectively alleviate aging-related bone loss and improve the microstructure of bone tissue in senile osteoporosis rats, and the regulation of autophagy might be one of the important mechanisms.

Comparative efficacy of acupuncture-related therapy for postmenopausal osteoporosis: protocol for Bayesian network meta-analysis

INTRODUCTION

The review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal osteoporosis, ranking the best acupuncture treatment and providing a reference for clinical treatment extensively.

METHODS AND ANALYSIS

Randomised controlled trials of different acupuncture-related therapies for postmenopausal osteoporosis will be searched in the following databases from 1 January 2002 to 31 December 2022, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database and China Biomedical Literature Database. Overall, clinical efficacy rate, bone mineral density and a Visual Analogue Scale score are used as the primary outcome indicators. In addition, the secondary outcome indicator is adverse reactions. The entire screening process will be conducted by two independent investigators; meanwhile, Stata (V.14.0) and RevMan (V.5.4) will be used to conduct the network meta-analysis. If the data are permissible and feasible, we will also perform meta-regression and subgroup analyses to address the underlying causes of data inconsistency and heterogeneity in the statistical analyses. Besides, to improve the credibility of this network meta-analysis, we will evaluate the quality of evidence in this research according to the GRADE assessment.

ETHICS AND DISSEMINATION

Ethics approval is not required for network meta-analyses, which do not involve animals' or people's welfare. The results of this network meta-analysis will be submitted to a recognised journal for publication.

PROSPERO REGISTRATION NUMBER

CRD42023401003.