Acupuncture and fracture risk in OA

Inspired by Huang et al 2022.[1]

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OA – osteoarthritis
JICM – Journal of Integrative and Complementary Medicine
JACM – Journal of Alternative and Complementary Medicine
VIP – very important person
aHR – adjusted hazard ratio

key to acronyms

This paper appeared online on the 14th of this month in JICM, and it was then that I realised that this is the renamed JACM, and that I can no longer seem to access it. Fortunately, our friend Ari was able to access it via a US contact. I had already tried two other colleagues and written directly to one of the corresponding authors.

JACM is now JICM

I have always been uncomfortable about the A in JACM, so I think the new name is a good move. The BMAS London office is in a London hospital that changed its name in November 2007 to include the term ‘Integrated Medicine’. I remember hearing that a certain VIP was not prepared to support an American neologism (integrative) in the name.

This is the latest of the large retrospective cohort studies from Taiwan, Korea and others. I have already written 22 blogs on these studies since December 2018, and this is the 27 paper I have identified. As observational studies they do not give us evidence of causative links; however, the associations are often intriguing and continue surprise me.

This paper identified patients (n=4253) with a new diagnosis of OA over a 14-year period from 1997 to 2010 inclusive. Of these, 1890 received acupuncture for their OA. These patients were matched with others who had not received acupuncture, which left 2 cohorts of 1708. Propensity score matching was performed based on age, sex, drug use, comorbidities, and surgical experience.

The index date was defined as the first time that the patients accepted acupuncture, so the immortal time was from initial OA diagnosis to the index date. I love the concept of a time period in which you cannot possibly die, particularly in view of recent events, and I even wrote a blog about it: Immortal time bias.

Those that received acupuncture had fewer fractures with an aHR of 0.57. This risk reduction was similar across all subgroups based on gender, age, comorbidities, use of drugs and arthroplasty (knee & hip).

Acupuncture is associated with a 43% reduction in fracture risk in OA

If the association indicates a causative link between acupuncture for OA and reduced fracture risk, we can hypothesise a variety of mechanisms, but the most obvious is probably related to the ease of use of affected joints in terms of increased pain free range and reduced stiffness.

This reduced risk of fracture of over 40% associated with acupuncture use adds to a long list of other reduced risks from these large retrospective cohorts studies:

  • coronary heart disease in patients with fibromyalgia in Taiwan [2] (aHR 0.43)
  • coronary heart disease in patients with rheumatoid arthritis in Taiwan [3] (aHR 0.60)
  • stroke in patients with depression in Taiwan [4] (aHR 0.49)
  • cervical surgery in patients with neck pain in Korea [5] (aHR 0.397)
  • knee surgery in patients with knee OA in Korea [6] (aHR 0.273)
  • Parkinson’s disease in patients with depression in Taiwan [7] (aHR 0.39)
  • stroke in patients with fibromyalgia in Taiwan [8] (aHR 0.53)
  • major adverse cardiovascular events in patients with hypertension in Korea [9] (aHR 0.83)
  • mortality, readmission and reoperation following hip fracture surgery in Taiwan [10] (aHRs 0.41, 0.64, 0.62)
  • coronary heart disease in patients with osteoarthritis in Taiwan [11] (aHR 0.33)
  • acromioplasty in patients with shoulder pain in Korea [12] (aHR 0.264)

1          Huang C-Y, Wu M-Y, Huang M-C, et al. The Association Between Acupuncture Therapies and Reduced Fracture Risk in Patients with Osteoarthritis: A Nationwide Retrospective Matched Cohort Study. J Integr Complement Med Published Online First: 14 February 2022. doi:10.1089/jicm.2021.0287

2          Wu M-Y, Huang M-C, Chiang J-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther 2017;19:37. doi:10.1186/s13075-017-1239-7

3          Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med 2018;18:341. doi:10.1186/s12906-018-2384-5

4          Chen L-Y, Yen H-R, Sun M-F, et al. Acupuncture treatment is associated with a decreased risk of developing stroke in patients with depression: A propensity-score matched cohort study. J Affect Disord 2019;250:298–306. doi:10.1016/j.jad.2019.03.020

5          Han D, Koh W, Shin J-S, et al. Cervical surgery rate in neck pain patients with and without acupuncture treatment: a retrospective cohort study. Acupunct Med Published Online First: August 2019. doi:10.1136/acupmed-2018-011724

6          Gang B-G, Shin J-S, Lee J, et al. Association Between Acupuncture and Knee Surgery for Osteoarthritis: A Korean, Nationwide, Matched, Retrospective Cohort Study. Front Med 2020;7:524628. doi:10.3389/fmed.2020.524628

7          Huang C-H, Lin M-C, Hsieh C-L. Acupuncture Treatment Reduces Incidence of Parkinson’s Disease in Patients With Depression: A Population-Based Retrospective Cohort Study in Taiwan. Front Aging Neurosci 2020;12:591640. doi:10.3389/fnagi.2020.591640

8          Huang M, Yen H-R, Lin C, et al. Acupuncture decreased the risk of stroke among patients with fibromyalgia in Taiwan: A nationwide matched cohort study. PLOS ONE 2020;15:e0239703. doi:10.1371/journal.pone.0239703

9          Jung H, Yeo S, Lim S. Effects of acupuncture on cardiovascular risks in patients with hypertension: a Korean cohort study. Acupunct Med Published Online First: June 2020. doi:10.1177/0964528420920290

10        Lin JC-F, Lin T-C, Cheng C-F, et al. Lower rates of mortality, readmission and reoperation in patients receiving acupuncture after hip fracture: a population-based analysis. Acupunct Med 2020;:096452842091166. doi:10.1177/0964528420911664

11        Ton G, Yang Y-C, Lee L-W, et al. Acupuncture Decreased the Risk of Coronary Heart Disease in Patients with Osteoarthritis in Taiwan: A Nationwide Matched Cohort Study. J Altern Complement Med 2020;18:acm.2020.0153. doi:10.1089/acm.2020.0153

12        Yang G, Jung B, Kim M-R, et al. Acromioplasty rates in patients with shoulder disorders with and without acupuncture treatment: a retrospective propensity score-matched cohort study. Acupunct Med 2020;38:255–63. doi:10.1177/0964528419895529

Declaration of interests MC