Outcomes of bisphosphonate therapy in kidney transplant recipients: a systematic review and meta‐analysis

Toth‐Manikowski, Stephanie M.; Francis, Jean; Gautam, Anju; Gordon, Craig E.

doi:10.1111/ctr.12792

Cited by 28 publications

(14 citation statements)

References 47 publications

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“…Bisphosphonates are generally not recommended in patients with eGFR <35 mL/min or evidence of adynamic bone disease due to avoiding over-suppression of bone remodeling. In KT recipients, bisphosphonates have efficacy in improving femoral neck and lumbar spine BMD [ 128 , 129 , 130 ]. Denosumab can be safely administered to CKD-associated osteoporosis, but its side effect of hypocalcemia should be cautious.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with CKD-MBD undergoing HD, ibandronate significantly increased BMD and decreased bone turnover [ 127 ]. In KT recipients, meta-analyses confirmed that bisphosphonates improved the femoral neck and lumbar spine BMD [ 128 , 129 , 130 ], but their effects on fracture risk and safety among KT recipients are not established [ 128 ].…”

Section: Management Of Chronic Kidney Disease-mineral and Bone Dismentioning

confidence: 99%

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Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Hsu

Chen

2020

IJMS

103

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Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD.

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Section: Discussionmentioning

confidence: 99%

Section: Management Of Chronic Kidney Disease-mineral and Bone Dismentioning

confidence: 99%

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Hsu

Chen

2020

IJMS

103

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“…However, among KTRs, bisphosphonates have largely demonstrated improvements in BMD without notable changes in fracture risk. Kan et al conducted a systematic review that noted an improvement solely in lumbar spine BMD ( 151 ), while the review performed by Toth-Manikowski et al demonstrated an association with improved lumbar spine BMD, as well as femoral BMD ( 152 ). Unfortunately, proof of improvement in clinical events is lacking from these reviews and trials.…”

Section: Treatmentmentioning

confidence: 99%

Mineral and Bone Disorders After Kidney Transplantation

2018

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The risk of mineral and bone disorders among patients with chronic kidney disease is substantially elevated, owing largely to alterations in calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23. The interwoven relationship among these minerals and hormones results in maladaptive responses that are differentially affected by the process of kidney transplantation. Interpretation of conventional labs, imaging, and other fracture risk assessment tools are not standardized in the post-transplant setting. Post-transplant bone disease is not uniformly improved and considerable variation exists in monitoring and treatment practices. A spectrum of abnormalities such as hypophosphatemia, hypercalcemia, hyperparathyroidism, osteomalacia, osteopenia, and osteoporosis are commonly encountered in the post-transplant period. Thus, reducing fracture risk and other bone-related complications requires recognition of these abnormalities along with the risk incurred by concomitant immunosuppression use. As kidney transplant recipients continue to age, the drivers of bone disease vary throughout the post-transplant period among persistent hyperparathyroidism, de novo hyperparathyroidism, and osteoporosis. The use of anti-resorptive therapies require understanding of different options and the clinical scenarios that warrant their use. With limited studies underscoring clinical events such as fractures, expert understanding of MBD physiology, and surrogate marker interpretation is needed to determine ideal and individualized therapy.

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“…There was an increase of around 3 % in both femoral neck and lumbar spine BMD, and an overall reduction in fractures, but no significant reduction in vertebral fractures. Two recent meta‐analyses re‐examined this question in 2016 and both confirmed the results of earlier studies, showing improved BMD at the femoral neck and lumbar spine; however, there no difference in fracture incidence . Adynamic bone disease remains a concern with the use of bisphosphonates.…”

Section: Introductionmentioning

confidence: 68%

Management of mineral and bone disorders in renal transplant recipients

Damasiewicz

Ebeling

2017

Nephrology

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ABSTRACT:The management of post-transplantation bone disease is a complex problem that remains under-appreciated in clinical practice. In these patients, preexisting metabolic bone disorder is further impacted by the use of immunosuppressive medications (glucocorticoids and calcineurin-inhibitors), variable post-transplantation renal allograft function and post-transplantation diabetes mellitus. The treatment of post-transplantation bone loss should begin pre-transplantation. All patients active on transplant waiting lists should be screened for bone disease. Patients should also be encouraged to take preventative measures against osteoporosis such as regular weight-bearing exercise, smoking cessation and reducing alcohol consumption. Biochemical abnormalities of disordered mineral metabolism should be corrected prior to transplantation wherever possible, and because these abnormalities commonly persist, post transplant hypophosphatemia, persistent hyperparathyroidism and low vitamin D levels should be regularly monitored and treated. Bone loss is greatest in the first 6-12 months post-transplantation, during which period any intervention is likely to be of greatest benefit. There is strong evidence that bisphosphonates prevent post-transplantation bone loss; however, data are lacking that this clearly extends to a reduction in fracture incidence. Denosumab is a potential alternative to vitamin D receptor agonists and bisphosphonates in reducing post-transplantation bone loss; however, further studies are needed to demonstrate its safety in patients with a significantly reduced estimated glomerular filtration rate. Clinical judgement remains the cornerstone of this complex clinical problem, providing a strong rationale for the formation of combined endocrinology and nephrology clinics to treat patients with Chronic Kidney Disease-Mineral and Bone Disorder, before and after transplantation.

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Outcomes of bisphosphonate therapy in kidney transplant recipients: a systematic review and meta‐analysis

Cited by 28 publications

References 47 publications

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Mineral and Bone Disorders After Kidney Transplantation

Management of mineral and bone disorders in renal transplant recipients

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