Pharmacological interventions versus placebo, no treatment or usual care for osteoporosis in people with chronic kidney disease stages 3-5D

• Published in: Cochrane database of systematic reviews 2021-07, Vol.7 (7), p.CD013424
• Main Authors: Hara, Takashi, Hijikata, Yasukazu, Matsubara, Yukiko, Watanabe, Norio
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Bias; Bone Density - drug effects; Bone Density Conservation Agents - adverse effects; Bone Density Conservation Agents - therapeutic use; CHRONIC KIDNEY DISEASE; Denosumab - adverse effects; Denosumab - therapeutic use; Female; Femur Neck - drug effects; Fractures, Spontaneous - epidemiology; Fractures, Spontaneous - prevention & control; Hip; Humans; Indoles - adverse effects; Indoles - therapeutic use; Kidney disease; Lumbar Vertebrae - drug effects; Osteoporosis, Postmenopausal - drug therapy; Osteoporosis, Postmenopausal - mortality; Osteoporosis, Postmenopausal - therapy; Parathyroid Hormone-Related Protein - adverse effects; Parathyroid Hormone-Related Protein - therapeutic use; Raloxifene Hydrochloride - adverse effects; Raloxifene Hydrochloride - therapeutic use; Randomized Controlled Trials as Topic; Renal Dialysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Spinal Fractures - diagnostic imaging; Spinal Fractures - prevention & control; Teriparatide - adverse effects; Teriparatide - therapeutic use; Thiophenes - adverse effects; Thiophenes - therapeutic use; Watchful Waiting
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD013424.pub2

Chronic kidney disease (CKD) is an independent risk factor for osteoporosis and is more prevalent among people with CKD than among people who do not have CKD. Although several drugs have been used to effectively treat osteoporosis in the general population, it is unclear whether they are also effective and safe for people with CKD, who have altered systemic mineral and bone metabolism. To assess the efficacy and safety of pharmacological interventions for osteoporosis in patients with CKD stages 3-5, and those undergoing dialysis (5D). We searched the Cochrane Kidney and Transplant Register of Studies up to 25 January 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Randomised controlled trials comparing any anti-osteoporotic drugs with a placebo, no treatment or usual care in patients with osteoporosis and CKD stages 3 to 5D were included. Two review authors independently selected studies, assessed their quality using the risk of bias tool, and extracted data. The main outcomes were the incidence of fracture at any sites; mean change in the bone mineral density (BMD; measured using dual-energy radiographic absorptiometry (DXA)) of the femoral neck, total hip, lumbar spine, and distal radius; death from all causes; incidence of adverse events; and quality of life (QoL). Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Seven studies involving 9164 randomised participants with osteoporosis and CKD stages 3 to 5D met the inclusion criteria; all participants were postmenopausal women. Five studies included patients with CKD stages 3-4, and two studies included patients with CKD stages 5 or 5D. Five pharmacological interventions were identified (abaloparatide, alendronate, denosumab, raloxifene, and teriparatide). All studies were judged to be at an overall high risk of bias. Among patients with CKD stages 3-4, anti-osteoporotic drugs may reduce the risk of vertebral fracture (RR 0.52, 95% CI 0.39 to 0