A Cochrane review [Abstract] 1 included 65 studies, of which 45 trials with a total of 2 698 subjects contributed to meta-analyses. Treatments included bisphosphonates, vitamin D compounds, teriparatide, denosumab, cinacalcet, parathyroidectomy, and calcitonin. Compared to placebo, bisphosphonate therapy administered over 12 months decreased fractures (table T1). Most fracture events were identified by routine surveillance radiographs of the spine, and may have not caused clinical symptoms. It was uncertain whether interventions for bone disease in kidney transplantation reduce all-cause or cardiovascular death, myocardial infarction or stroke, or graft loss. Bisphosphonate therapy decreased acute graft rejection and bone pain (table T1). It is uncertain whether vitamin D (table T2) or any other therapy made any difference to fracture risk.
| Outcome | Relative effect(95% CI) | Risk with placebo or no treatment | Risk with intervention - Bisphosphonate (95% CI) | No. of participants(studies)Certainty of evidence |
|---|---|---|---|---|
| Fracture | RR 0.62(0.38 to 1.01) | 95 per 1000 | 59 per 1000(36 to 96) | 765 (13) Low |
| Acute graft rejection | RR 0.70(0.55 to 0.89) | 404 per 1000 | 282 per 1000(222 to 359) | 470 (7) Low |
| Bone pain | RR 0.20(0.04 to 0.93) | 133 per 1000 | 27 per 1000(5 to 124) | 153 (3) Low |
| Outcome | Relative effect(95% CI) | Risk with placebo or no treatment | Risk with intervention - Vitamin D (95% CI) | No. of participants(studies)Certainty of evidence |
|---|---|---|---|---|
| Fracture | RR 0.96(0.10 to 8.94) | 7 per 1000 | 7 per 1000(1 to 61) | 299 (5) Very low |
| Acute graft rejection | RR 0.98(0.52 to 1.86) | 89 per 1000 | 87 per 1000(46 to 165) | 385 (5) Very low |
| Bone pain | not estimable | 0 per 1000 | 0 per 1000(0 to 0) | 40 (1) Very low |
Comment: The quality of evidence is downgraded by limitations in study quality (unclear allocation concealment and selective reporting) and imprecise results (few events and wide confidence intervals).
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