title: Benefits and Harms of Osteoporosis Medications in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Complications of chronic kidney disease (CKD) include weak bones and increased fracture risk.
  
  
  OBJECTIVE
  To review the benefits and harms of osteoporosis medications (bisphosphonates, teriparatide, raloxifene, and denosumab) compared with placebo, usual care, or active control in terms of bone mineral density (BMD), fractures, and safety in patients with CKD.
  
  
  METHODS
  PubMed and the Cochrane Central Register of Controlled Trials from December 2006 through December 2016.
  
  
  METHODS
  Paired reviewers independently screened abstracts and full-text articles for English-language, randomized, controlled trials that had at least 6 months of follow-up; evaluated osteoporosis medications among patients with CKD; and reported on BMD, fractures, or safety (mortality and adverse events).
  
  
  METHODS
  Two reviewers serially abstracted data and independently assessed risk of bias and graded the strength of evidence (SOE).
  
  
  RESULTS
  There were 13 trials (n = 9850) that included kidney transplant recipients (6 trials), patients who had stage 3 to 5 CKD or were receiving dialysis (3 trials), or postmenopausal women with CKD (4 trials). Evidence showed that bisphosphonates may slow loss of BMD among transplant recipients (moderate SOE), but their effects on fractures and safety in transplant recipients and others with CKD are unclear. Raloxifene may prevent vertebral fractures but may not improve BMD (low SOE). Effects of teriparatide and denosumab on BMD and fractures are unclear (very low SOE), and these medications may increase risk for some safety outcomes.
  
  
  CONCLUSIONS
  Unclear rigor of evidence, possible reporting biases, and scant evidence among patients with stage 3 to 5 CKD.
  
  
  CONCLUSIONS
  Effects of osteoporosis medications on BMD, fracture risk, and safety among patients with CKD are not clearly established.
  
  
  BACKGROUND
  Kidney Disease: Improving Global Outcomes.
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wilson
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Rebholz
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Ermias
authors.initials: E
authors.lastname: Jirru
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Marisa Chi
authors.initials: MC
authors.lastname: Liu
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Allen
authors.initials: A
authors.lastname: Zhang
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gayleard
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Yue
authors.initials: Y
authors.lastname: Chu
authors.affiliation: From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Robinson
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000069448:Denosumab / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010024:Osteoporosis / Q000150:complications* / Q000188:drug therapy*; D020849:Raloxifene Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D019379:Teriparatide / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019379:Teriparatide; D000069448:Denosumab; D020849:Raloxifene Hydrochloride