title: Bisphosphonates for preventing bone disease in kidney transplant recipients: a meta-analysis of randomized controlled trials.
abstract: An estimated 60% of kidney transplant recipients have mineral bone disease and about 0.5% break their hip within the first year after transplantation. We conducted a systematic review of benefits and harms of bisphosphonates in kidney transplant recipients. We searched CENTRAL (Issue 5, 2015) for randomized controlled trials in all languages and screened the reference list of an earlier Cochrane review. One reviewer identified the trials, extracted all data, and assessed risk of bias. Meta-analysis used a random effects model, with results expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Bisphosphonates have uncertain effects on death (RR 0.45, CI 0.04-4.69) and vertebral fractures (RR 0.58, CI 0.24-1.43, I(2) 0%). Bisphosphonates moderately to importantly reduce the loss of vertebral bone mineral density (MD 5.98%, CI 3.77-8.18% change from baseline in g calcium/cm² at 12 months, I(2) 91%) and femoral bone mineral density (MD 5.57%, 3.12-8.01% change from baseline in g calcium/cm² at 12 months, I(2) 69%). At this stage, insufficient evidence exists to support routine use of bisphosphonates to reduce fracture risk after kidney transplantation. Data on important health outcomes are lacking, surrogate outcomes poorly reflect bone quality in kidney transplant recipients, and serious adverse events are not studied and reported systematically.
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Emmanuelle B
authors.initials: EB
authors.lastname: Versele
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Van Laecke
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Annemieke W
authors.initials: AW
authors.lastname: Dhondt
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Francis
authors.initials: F
authors.lastname: Verbeke
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.|European Renal Best Practice (ERBP), guidance body of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), Ghent, Belgium.
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.|European Renal Best Practice (ERBP), guidance body of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.affiliation: Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.|European Renal Best Practice (ERBP), guidance body of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), Ghent, Belgium.
authors.forename: Evi V
authors.initials: EV
authors.lastname: Nagler
mesh_terms: D015982:Bias; D015519:Bone Density; D001847:Bone Diseases / Q000517:prevention & control*; D002116:Calcitonin / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*
chemical_list: D004164:Diphosphonates; D002116:Calcitonin
keywords: bisphosphonates; kidney transplantation; systematic review