Osteoporosis (OP) is a systemic bone disease characterized by decreased bone mass, damaged bone tissue microstructure, increased bone fragility, and susceptibility to fractures. In China, the population with OP is large. With the increase of age, not only the bone health but also the muscle strength gradually declines. Currently, there are few studies on the dynamic balance between muscle-bone-fat and the pathogenesis of OP.

The purpose of this study is to explore the distribution pattern of TCM syndrome types in OP patients and their relationship with muscle-bone-fat, and to explore the clinical characteristics of OP patients from the perspective of TCM syndrome differentiation, so as to better prevent the occurrence of OP and further exert the advantages of TCM in the diagnosis and treatment of OP.

From July 19, 2019 to January 31, 2022, 108 OP patients were recruited at the Third Affiliated Hospital of Guangzhou University of Chinese Medicine. Among them, 97 were female and 11 were male, with an age range of 49 to 88 years and an average age of (62.9±7.2) years. The general clinical data of the patients were recorded. According to different TCM syndrome types, the patients were divided into 39 cases in the liver-kidney yin deficiency group, 53 cases in the spleen-kidney yang deficiency group, and 16 cases in the qi stagnation and blood stasis group. The bone mineral density of the anterior-posterior lumbar vertebrae (L1-L4) of the patients was detected by DXA, and 25-hydroxyvitamin D [25(OH)D], 1, 25-dihydroxyvitamin D [1, 25-(OH)₂D], fibroblast growth factor 23 (FGF-23), semaphorin 4D (SEMA4D), and serum soluble receptor activator of nuclear factor κB ligand (sRANKL) were detected by ELISA.

The results showed that there were statistically significant differences in bone mineral content and fat mass among different TCM syndrome type groups (P<0.05). The bone mineral content of the spleen-kidney yang deficiency group and the qi stagnation and blood stasis group was higher than that of the liver-kidney yin deficiency group, the fat mass of the spleen-kidney yang deficiency group was lower than that of the liver-kidney yin deficiency group, and the fat mass of the qi stagnation and blood stasis group was higher than that of the spleen-kidney yang deficiency group, with statistically significant differences (P<0.05). There were statistically significant differences in the severe OP rate among different syndrome types. The OP rate of the liver-kidney yin deficiency group was higher than that of the qi stagnation and blood stasis group. There were statistically significant differences in severe OP sRANKL among different syndrome types (P<0.05). The sRANKL of the spleen-kidney yang deficiency group was lower than that of the liver-kidney yin deficiency group (P<0.05). Bone mineral content was positively correlated with fat mass and muscle mass; fat mass was positively correlated with muscle mass, 1, 25-(OH)₂D, FGF-23, SEMA4D, and sRANKL; 25(OH)D was positively correlated with 1, 25-(OH)₂D, FGF-23, SEMA4D, and sRANKL; 1, 25-(OH)₂D was positively correlated with FGF-23, SEMA4D, and sRANKL; FGF-23 was positively correlated with SEMA4D and sRANKL; SEMA4D was positively correlated with sRANKL (P<0.05).

With the increase of age, spleen-kidney deficiency, muscle weakness, and bone insufficiency occur, leading to bone atrophy. Further, water retention occurs internally, generating phlegm and fat, which disrupts the dynamic balance between muscle-bone-fat in the body. In patients with different TCM syndrome types of OP, there are certain differences in muscle, bone, and fat mass, and fat mass is correlated with bone metabolism biochemical indicators.