Bisphosphonate Therapy after Liver Transplant Improves Bone Mineral Density and Reduces Fracture Rates: An Updated Systematic-Review and Meta-Analysis.
Ho, O. T. W., et al. (2021).Transplant International [record in progress].
Aims
This study aimed to determine the efficacy of bisphosphonates in reducing the incidence of fracture, and to compare the effects of oral versus intravenous (IV) administration of bisphosphonate therapy on bone mineral density (BMD) and the incidence of fracture in post-orthotopic liver transplant (OLT) recipients.
Interventions
Electronic databases including Medline and Embase were searched. Two independent reviewers selected studies for inclusion. The methodological quality of the included studies were assessed using the Newcastle-Ottowa Scale and Jadad Scale for cohort studies and randomised controlled trials.
Participants
9 studies were included in the review.
Outcomes
The main outcomes were changes in post-OLT BMD, the incidence of fracture and adverse reactions.
Follow-up
N/A
CET Conclusions
The systematic review and meta-analysis investigates the efficacy of bisphosphonates regarding the incidence of fractures, bone mineral density (BMD) changes and adverse reactions in liver transplant recipients. Medline and Embase were searched and six randomised controlled trials and three cohort studies met the inclusion criteria (n=645). Most studies were considered to be of good methodological quality. Study selection was done by independent reviewers but it was unclear if data extraction and methodological quality assessment was done in duplicate. The majority of patients started on bisphosphonates irrespective of BMD changes. The total and vertebral fracture incidence was significantly lower in patients taking bisphosphonates compared with patients on vitamin D and calcium. BMD of the lumbar spine and neck of femur were also significantly improved in patients taking bisphosphonates. Subgroup analyses of patients taking oral versus intravenous bisphosphonates showed improvements in BMD and the rate of fractures for patients taking oral bisphosphonates but the same effect was not seen in patients who received intravenous bisphosphonates. None of the studies reported serious adverse events.
Trial registration
N/A