Comparative efficacy and safety of anti-osteoporotic therapies for kidney transplant recipients: a systematic review and network meta-analysis
Abstract
Background: Kidney transplant recipients (KTRs) are at an increased risk of osteoporosis, which negatively impacts their quality of life and transplant outcomes. However, the efficacy and safety of anti-osteoporosis treatments in this group remain uncertain.
Methods: We conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to August 1, 2024. Randomized controlled trials (RCTs) examining anti-osteoporotic medications in KTRs were included. Primary outcomes were changes in bone mineral density (BMD) at femoral neck and lumbar spine, and adverse events. We performed a frequentist network meta-analysis using random-effects models. Evidence certainty was assessed using the GRADE approach.
Results: Twenty-one RCTs involving 1,066 participants were included, published between 2000 and 2021. For femoral neck BMD, bisphosphonates significantly improved BMD compared to control (MD = 0.04, 95%CI=0.00-0.09, p<0.05) based on low certainty evidence, while calcitonin was significantly superior to calcium (MD=-0.14, 95%CI=-0.28 to -0.01). Most other comparisons showed no statistically significant differences based on very low to moderate certainty evidence. For lumbar spine BMD, bisphosphonates, calcitonin, and calcium demonstrated statistically significant inferiority compared to denosumab, with bisphosphonates showing MD=-4.98 (95%CI=-6.84 to -3.13), calcitonin showing MD=-4.35 (95%CI=-6.24 to -2.47), and calcium showing…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,066 participants or records.
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