title: Clinical efficacy and safety of pamidronate therapy on bone mass density in early post-renal transplant period: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The overall effect of pamidronate on bone mass density (BMD) in the early renal transplant period varies considerably among studies. The effects of pamidronate on graft function have not been determined.
  
  
  METHODS
  A comprehensive search was conducted in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase independently by two authors. Randomized controlled trials of pamidronate evaluating bone loss in the first year of renal transplantation were included. Methods reported in the "Cochrane Handbook for Systematic Reviews of Interventions 5.0.2" were used to evaluate changes of lumbar spine and femoral neck BMD, and serum creatinine, calcium and intact parathyroid hormone (iPTH) levels. Fixed or random effect models were used as appropriate.
  
  
  RESULTS
  Six randomized trials evaluating 281 patients were identified. One hundred forty-four were treated with pamidronate and 137 were control patients. Administration of pamidronate was associated with significant reduction of bone loss in the lumbar spine, compared to the control group (standardized mean difference (SMD)  = 24.62 [16.25, 32.99]). There was no difference between the pamidronate treated and control femoral neck BMD (SMD  = 3.53 [-1.84, 8.90]). A significant increase in the serum creatinine level of the intervention group was seen, compared to the control group. The serum calcium and iPTH of the pamidronate and control groups were not different after 1 year (serum creatinine: SMD  = -3.101 [-5.33, -0.89]; serum calcium: SMD  = 2.18 [-0.8, 5.16]; serum iPTH: SMD  = 0.06 [-0.19, 0.31]). Heterogeneity was low for serum calcium and iPTH and high for serum creatinine.
  
  
  CONCLUSIONS
  This meta-analysis demonstrated the beneficial clinical efficacy of pamidronate on BMD with no association with any alteration in graft function during the first year of renal transplantation. Significant heterogeneity precludes the conclusion of the relationship between serum creatinine and pamidronate.
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Zijie
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Han
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tao
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Lu
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xuzhong
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Bian
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Zhengkai
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Changjun
authors.initials: C
authors.lastname: Yin
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Ruoyun
authors.initials: R
authors.lastname: Tan
authors.affiliation: Department of urology, the first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Min
authors.initials: M
authors.lastname: Gu
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016030:Kidney Transplantation; D000077268:Pamidronate; D016032:Randomized Controlled Trials as Topic; D016103:Spinal Fractures; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007166:Immunosuppressive Agents; D000077268:Pamidronate