Pharmacological Interventions for Osteoporosis in Kidney Transplant Recipients: A Systematic Review and Meta-analysis

Osteoporosis is a common complication after kidney transplantation and contributes to fracture risk and morbidity among kidney transplant recipients (KTRs). However, the efficacy of pharmacological interventions for osteoporosis in this population remains uncertain.

Systematic review and meta-analysis.

KTRs.

PubMed, Scopus, and the Cochrane Library were searched through December 2024 for randomized controlled trials evaluating pharmacological treatments' effects on bone turnover markers, bone mineral density (BMD), and fracture incidence in KTRs.

Three independent reviewers extracted study characteristics, type of pharmacological interventions and comparators, and outcomes, including bone turnover markers, BMD, and fracture rates.

A random-effects model was used to calculate weighted mean differences (WMD) for continuous outcomes and relative risks for categorical outcomes.

A total of 33 randomized controlled trials (2,623 KTRs) were included in this meta-analysis. Pharmacological treatment was not associated with significant changes in parathyroid hormone, bone alkaline phosphatase, and osteocalcin levels. In subgroup analysis, only active vitamin D showed a significant reduction in parathyroid hormone levels (WMD -25.18 pg/mL [-32.59 to -17.77]). Interestingly, pharmacological therapy significantly improved BMD at lumbar spine (WMD 0.04 g/cm² [0.00 to 0.08]; P = 0.04), radius (WMD 0.14 g/cm² [0.08-0.19]; P < 0.001), and femoral neck (WMD 0.05 g/cm² [0.03-0.07]; P < 0.001). However, no significant improvement in BMD was observed at the hip (WMD 0.03 g/cm² [-0.01 to 0.07]; P = 0.12). Furthermore, there was no statistically significant reduction in fracture risk (RR 0.38 [0.14-1.01]; P = 0.05).

Significant clinical and statistical heterogeneity (I²) because of varied pharmacological agents, initiation timing, and recipient characteristics.

Pharmacological interventions for osteoporosis in KTRs significantly improved BMD at several skeletal sites, particularly radius site. However, a nonsignificant trend toward reduced fracture incidence was observed.