Outcomes of Bisphosphonate and Its Supplements for Bone Loss in Kidney Transplant Recipients: a Systematic Review and Network Meta-analysis

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2018 Oct 21

PMID 30340537

Citations 2

Authors

Yan Yang

Shi Qiu

Linghui Deng

Xi Tang

Xinrui Li

Qiang Wei

Ping Fu

Affiliations

Soon will be listed here.

Abstract

Background: Mineral bone disease constitutes a common complication of post-kidney transplantation, leading to great disability. As there is no consensus on the optimal treatment for post-kidney transplant recipients (KTRs), we aimed to evaluate the efficacy and safety of bisphosphonate and its combined therapies.

Methods: We incorporated relevant trials to perform a network meta-analysis from direct and indirect comparisons. We searched PubMed, Embase and the CENTRAL and the reference lists of relevant articles up to August 1, 2017, for randomized controlled trials. The primary outcome was bone mineral density (BMD) change at the femoral neck and the lumbar spine.

Results: From a total of 864 citations, 18 randomized controlled trials with a total of 1200 participants were included. Five different regimens were considered. Bisphosphonate plus calcium revealed a significant gain in percent BMD change than calcium alone at the femoral neck (mean difference (MD), 5.83; 95% credible interval (CrI), 1.61 to 9.27). No significant difference was detected when restricting to absolute terms. At the lumbar spine, bisphosphonate and calcium with or without vitamin D analogs outperformed calcium solely (MD, 0.07; 95% CrI, 0.00 to 0.13; MD, 0.06; 95% CrI, 0.02 to 0.09). Compared to calcium with vitamin D analogs, adding bisphosphonate was associated with marked improvement (MD, 0.03; 95% CrI, 0.00 to 0.05). Considering percent terms, combination of bisphosphonate with calcium and vitamin D analogs showed greater beneficial effects than calcium alone or with either vitamin D analogs or calcitonin (MD, 10.51; 95% CrI, 5.92 to 15.34; MD, 5.48; 95% CrI, 2.57 to 8.42; MD, 6.39; 95% CrI, 0.55 to 12.89). Both bisphosphonate and vitamin D analogs combined with calcium displayed a notable improvement compared to calcium alone (MD, 7.24; 95% CrI, 3.73 to 10.69; MD, 5.02; 95% CrI, 1.20 to 8.84).

Conclusions: Our study suggested that additional use of bisphosphonate was well-tolerated and more favorable in KTRs to improve BMD.

Citing Articles

The Impact of Cholecaciferol Supplementation on Bone Mineral Density in Long-Term Kidney Transplant Recipients.

Battaglia Y, Bellasi A, Esposito P, Bortoluzzi A, Rotondi S, Andreucci M Biomolecules. 2023; 13(4).

PMID: 37189376 PMC: 10135898. DOI: 10.3390/biom13040629.

Early steroid withdrawal has a positive effect on bone in kidney transplant recipients: a propensity score study with inverse probability-of-treatment weighting.

Batteux B, Gras-Champel V, Lando M, Brazier F, Mentaverri R, Desailly-Henry I Ther Adv Musculoskelet Dis. 2020; 12:1759720X20953357.

PMID: 33193832 PMC: 7604996. DOI: 10.1177/1759720X20953357.

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