The Efficacy and Safety of Bisphosphonate Therapy for Osteopenia/Osteoporosis in Patients With Chronic Kidney Disease: A Systematic Review and Individual Patient-Level Meta-Analysis of Placebo-Controlled Randomized Trials.

IF 1.6 Q3 UROLOGY & NEPHROLOGY Canadian Journal of Kidney Health and Disease Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI:10.1177/20543581241283523
Reid Whitlock, Kerry MacDonald, Navdeep Tangri, Michael Walsh, David Collister
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Abstract

Background: The efficacy and safety of bisphosphonate therapy for the treatment of osteoporosis and osteopenia in the setting of chronic kidney disease (CKD) is unclear.

Objective: To determine the effect of bisphosphonate therapy on fractures, bone mineral density (BMD), and adverse events in adults across the spectrum of CKD and dialysis.

Design: Systematic review and individual patient-level meta-analysis.

Setting: Searches of Ageline, CINAHL, the Cochrane Library, EMBASE, and Medline from inception to August 25, 2016, supplemented with manual screening and clinicalstudydatarequest.com. Authors were contacted for individual patient-level data.

Patients: Randomized, placebo-controlled trials with 100 or more participants that evaluated the treatment of primary osteoporosis/osteopenia in adult men and women with bisphosphonate therapy.

Measurements: Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were fractures, BMD, and adverse events including decline in estimated glomerular filtration rate (eGFR) and hypocalcemia (calcium <2.00 mmol/L).

Methods: Single-stage individual patient-level meta-analysis.

Results: Of 39 eligible studies, individual patient-level data was available for 7 studies, all of which were studies of ibandronate. Of 7428 participants (5010 ibandronate, 2418 placebo), 100% were female, 98.6% were white, the mean body mass index was 25.7 kg/m2 (SD 3.9), 18.9% were smokers and there were 740 fracture events. The mean eGFR was 69.1 mL/min/1.73 m2 (SD 15.9) including 14.5%, 54.9%, 27.5%, 3.0%, and 0.2% stages G1, G2, G3A, G3B, and G4 CKD. Ibandronate increased hip and lumbar spine BMD and decreased the risk of fracture in the overall population (hazard ratio (HR) 0.871, 95% confidence interval (CI) 0.746, 1.018) but in patients with stage G3B CKD, it increased the risk of fracture (HR 3.862, 95% CI 1.156, 12.903). Ibandronate did not impact eGFR over 12 months but increased the risk of hypocalcemia (HR 1.324, 95% CI 1.056, 1.660) with no evidence of any effect modification by CKD stage (all tests of interaction p > 0.05).

Limitations: Clinically significant heterogeneity among studies, lack of long-term follow-up and bone biopsy results, limited representation of stage G4 and G5 CKD patients.

Conclusions: Chronic kidney disease potentially modifies the efficacy but not the safety of bisphosphonate therapy in osteopenia and osteoporosis.

Registration: PROSPERO CRD42020145613.

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双膦酸盐疗法治疗慢性肾病患者骨质疏松/骨质疏松症的有效性和安全性:安慰剂对照随机试验的系统回顾与个体患者层面的 Meta 分析》。
背景:双膦酸盐疗法治疗慢性肾脏病(CKD)患者骨质疏松症和骨质疏松症的疗效和安全性尚不明确:目的:确定双膦酸盐疗法对各种慢性肾脏病和透析成人的骨折、骨矿物质密度(BMD)和不良事件的影响:设计:系统综述和单个患者水平的荟萃分析:检索从开始到 2016 年 8 月 25 日的 Ageline、CINAHL、Cochrane Library、EMBASE 和 Medline,并辅以人工筛选和 clinicalstudydatarequest.com。我们联系了作者以获取患者的个人数据:参试人数在 100 人以上的随机安慰剂对照试验,这些试验评估了使用双膦酸盐疗法治疗成年男性和女性原发性骨质疏松症/骨质疏松症的效果:研究特点、质量和数据由两名评审员独立评估。结果指标为骨折、BMD和不良事件,包括估计肾小球滤过率(eGFR)下降和低钙血症(钙方法):单阶段单个患者水平荟萃分析:在 39 项符合条件的研究中,有 7 项研究提供了患者个体水平的数据,所有这些研究都是关于伊班膦酸钠的研究。在7 428名参与者(5010名伊班膦酸盐患者,2 418名安慰剂患者)中,100%为女性,98.6%为白人,平均体重指数为25.7 kg/m2(SD 3.9),18.9%为吸烟者,共发生了740起骨折事件。平均 eGFR 为 69.1 mL/min/1.73 m2(SD 15.9),包括 14.5%、54.9%、27.5%、3.0% 和 0.2% 的 G1、G2、G3A、G3B 和 G4 期慢性肾脏病患者。伊班膦酸钠能增加髋部和腰椎 BMD,降低总体人群的骨折风险(危险比 (HR) 0.871,95% 置信区间 (CI) 0.746-1.018 ),但在 G3B 期 CKD 患者中,它增加了骨折风险(HR 3.862,95% CI 1.156-12.903)。伊班膦酸钠对12个月内的eGFR没有影响,但会增加低钙血症的风险(HR 1.324,95% CI 1.056,1.660),没有证据表明CKD分期会改变影响(所有交互检验P>0.05):局限性:各研究之间存在明显的临床异质性,缺乏长期随访和骨活检结果,G4和G5期慢性肾脏病患者的代表性有限:慢性肾病可能会改变双膦酸盐治疗骨质疏松症和骨质疏松症的疗效,但不会改变其安全性:PROPRONO CRD42020145613.
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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
84
审稿时长
12 weeks
期刊介绍: Canadian Journal of Kidney Health and Disease, the official journal of the Canadian Society of Nephrology, is an open access, peer-reviewed online journal that encourages high quality submissions focused on clinical, translational and health services delivery research in the field of chronic kidney disease, dialysis, kidney transplantation and organ donation. Our mandate is to promote and advocate for kidney health as it impacts national and international communities. Basic science, translational studies and clinical studies will be peer reviewed and processed by an Editorial Board comprised of geographically diverse Canadian and international nephrologists, internists and allied health professionals; this Editorial Board is mandated to ensure highest quality publications.
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