Outcomes of bisphosphonate therapy in kidney transplant recipients: a systematic review and meta-analysis.
Mineral and bone disorders that precede kidney transplantation are exacerbated in the post-transplant setting by tertiary hyperparathyroidism and immunosuppressive regimens. Bone mineral density (BMD) decreases following transplantation, leading to increased fracture risk. The effect of bisphosphonates on fracture is unknown. The aim of this study was to update estimates of change in BMD and fracture rates in bisphosphonate-treated kidney transplant recipients through meta-analysis. Studies comparing bisphosphonate therapy to standard of care were included if follow-up duration was more than 6 months. We performed random-effects meta-analysis to determine the effect of bisphosphonates on lumbar spine and femoral neck BMD and fracture rates. Bisphosphonates improved femoral neck and lumbar spine BMD compared with controls (0.055 g/cm(2) , 95% CI 0.012-0.099 and 0.053 g/cm(2) , 95% CI 0.032-0.074, respectively) without adversely affecting serum creatinine or calcium. This corresponded to an unweighted improvement in BMD of 6.0% and 7.4%, respectively. There was no difference in fracture incidence in the two groups. Bisphosphonate therapy in kidney transplant recipients is associated with a statistically significant improvement in BMD at the lumbar spine and femoral neck. There was no difference in fracture incidence. Bisphosphonates did not adversely affect allograft dysfunction or serum calcium levels.
Department of Medicine, Boston University School of Medicine, Boston, MA, USA.|Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Stephanie M
SM
Toth-Manikowski
Renal Section and Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Jean M
JM
Francis
Section of Transplant Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
Amitabh
A
Gautam
Renal Section and Department of Medicine, Boston University School of Medicine, Boston, MA, USA. craig.gordon@bmc.org.
Craig E
CE
Gordon
D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000378:metabolism; D004164:Diphosphonates / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D066027:Transplant Recipients
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D002118:Calcium
bisphosphonate; bone mineral density; bone mineral disorders; fracture; kidney transplantation