title: Prevention of fractures after solid organ transplantation: a meta-analysis.
abstract: BACKGROUND
  Bone loss and fracture are serious sequelae of organ transplantation, particularly in the first posttransplant year. Most interventional studies have been inadequately powered to detect effects on fracture.
  
  
  OBJECTIVE
  The objective of the study was to determine whether treatment with bisphosphonates (BP) or active vitamin D analogs (vitD) during the first year after transplantation reduces fracture risk and estimate the effect of these interventions on bone loss.
  
  
  METHODS
  Sources included PUBMED, MEDLINE, Cochrane Library, and abstracts from scientific meetings (presented 2003-2010).
  
  
  METHODS
  Randomized controlled clinical trials of BP or vitD in solid organ transplant recipients were included if treatment was initiated at the time of transplantation and fracture data were collected.
  
  
  METHODS
  Two investigators independently extracted data and rated study quality. Fixed effect and random-effects models were used to obtain pooled estimates.
  
  
  RESULTS
  Eleven studies of 780 transplant recipients (134 fractures) were included. Treatment with BP or vitD reduced the number of subjects with fracture [odds ratio (OR) 0.50 (0.29, 0.83)] and number of vertebral fractures, [OR 0.24 (0.07, 0.78)]. An increase in bone mineral density at the lumbar spine [2.98% (1.31, 4.64)] and femoral neck [3.05% (2.16, 3.93)] was found with treatment. When BP trials (nine studies, 625 subjects) were examined separately, there was a reduction in number of subjects with fractures [OR 0.53 (0.30, 0.91)] but no significant reduction in vertebral fractures [OR 0.34 (0.09, 1.24)].
  
  
  CONCLUSIONS
  Treatment with BP or vitD during the first year after solid organ transplant was associated with a reduction in the number of subjects with fractures and fewer vertebral fractures.
authors.affiliation: Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Stein
authors.forename: Dionisio
authors.initials: D
authors.lastname: Ortiz
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D015519:Bone Density / Q000187:drug effects; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D011184:Postoperative Period; D014807:Vitamin D / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D004164:Diphosphonates; D014807:Vitamin D