Transplant Trial Watch

Interventions for preventing bone disease in kidney transplant recipients.

Palmer, S. C., et al.

Cochrane Database of Systematic Reviews 2019; 10: CD005015.

The aim of this study was to investigate the effects of using pharmacotherapeutic agents for treating bone disease following renal transplantation.

The electronic databases searched included MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Additionally, reference lists of relevant textbooks, trials and review articles, and letters to investigators involved in previous trials seeking information about incomplete or unpublished trials, were also searched. The assessment of risk of bias and data extraction were performed by two independent reviewers.

A total of 23 randomized controlled trials from 30 publications were included in the review.

The primary outcome was fracture at any site after renal transplantation. Other outcome measures were absolute changes in bone mineral density, presence of low bone turnover, acute rejection, plasma creatinine at the end of treatment and overall mortality.


CET Conclusions
This is a detailed report of a large and well-conducted systematic review including 23 trials (1209 patients). Multiple databases were searched and references were sifted, assessed and data extracted in duplicate by two authors. The primary outcome of interest was fracture incidence in transplant recipients. The review concluded that no intervention was shown to significantly improve this outcome despite some evidence for improved bone mineral density in the lumbar spine and femoral neck with bisphosphonates, vitamin D analogues and calcitonin. Several meta-analyses are presented, with as few as 2 studies in each. The reporting of trial methods was inadequate or incomplete in the majority of included studies. The authors bemoan the paucity of high level evidence in this area and provide a power calculation to inform a future study on this topic, suggesting that it would be feasible in a multicentre study with 266 enrolments.

Quality notes
SR-QA not applicable

Trial registration

Funding source
Non-industry funded