Pharmacological intervention and placebo, no treatment or usual care for osteoporosis in people with stage 3-5D chronic kidney disease

Hara T, Hikata Y, Matsubara Y, Watanabe N. Pharmacological intervention and placebo, no treatment or usual care for osteoporosis in people with stages 3-5D of chronic kidney disease. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013424. doi: 10.1002 /14651858.CD013424.pub2. Accessed July 31, 2021.

Commentary

This study was designed to evaluate the efficacy and safety of pharmacological interventions for osteoporosis in patients with CKD stages 3-5 and patients on dialysis (5D).

Seven studies, including 9164 randomized participants with osteoporosis and CKD stage 3~5D, met the selection criteria and were reviewed as the main results. All participants were postmenopausal women, five studies included patients with CKD stage 3-4, and two studies included patients with CKD stage 5 or 5D.

Five pharmacological interventions were identified.

Abaloparatide.

Alendronate

Denosumab

Raloxifene

Teriparatide

All studies were judged to have an overall high risk of bias.

Antiosteoporotic drugs in patients with CKD stage 3-4 may reduce the risk of vertebral fractures, but antiosteoporotic drugs made no difference at all in the risk of clinical fractures or adverse events. This is because the study could not be incorporated into a meta-analysis of BMD for femoral neck, lumbar spine, and total hip replacement because only the percent change in BMD in the intervention group was reported.

It is unclear whether antiosteoporotic drugs reduce the risk of clinical fracture in patients with severe CKD stages 5 and 5D, but the certainty of this evidence is very low, so it is unclear whether antiosteoporotic drugs improve BMD of the femoral neck.

Antiosteoporotic drugs may slightly improve BMD of the lumbar spine, and no adverse events have been reported in the included studies. It is also unclear whether antiosteoporotic drugs reduce the risk of death.

The authors conclude that

In patients with CKD stage 3-4, antiosteoporotic drugs may reduce the risk of vertebral fractures with low certainty evidence. In patients with CKD stages 5 and 5D, the certainty of this evidence is so low that it is unclear whether antiosteoporotic drugs reduce the risk of clinical fractures and death. It is unclear whether they do. Antiosteoporotic drugs may slightly improve BMD of the lumbar spine with less certainty of evidence. Because of the very low certainty of this evidence, it is not known whether antiosteoporotic drugs improve BMD of the femoral neck.