Wang J, Yao M, Xu J-h, Shu B, Wang Y-j, Cui X-j
Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
Osteoporos Int. 2016 May;27(5):1683-90. doi: 10.1007/s00198-015-3465-7. Epub 2016 Jan 5.
We conducted a systematic review of randomized controlled trials (RCTs) of bisphosphonates for the prevention of osteopenia in kidney-transplant recipients. Bisphosphonates improved bone mineral density at the lumbar spine and femoral neck after 12 months. However, additional well-designed RCTs are required to determine the optimal treatment strategy. Osteopenic-osteoporotic syndrome is a bone complication of renal transplantation. Bisphosphonates, calcitonin, and vitamin D analogs may be used to prevent or treat osteoporosis or bone loss after renal transplantation. However, there is currently no widely recognized strategy for the prevention of corticosteroid-induced osteoporosis. This study aims to assess the available evidence to guide the targeted use of bisphosphonates for reducing osteoporosis and bone loss in renal-transplant recipients. We searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE for randomized controlled trials of bisphosphonates for osteoporosis or bone loss after renal transplantation. A total of 352 abstracts were identified, of which 55 were considered for evaluation and 9 were included in the final analysis. The primary outcome measure was change in the bone mineral density (BMD) of the lumbar spine and femoral neck after 12 months. Data extraction was performed independently by two investigators. BMD at the lumbar spine was improved after treatment with bisphosphonates [9 trials; 418 patients; weighted mean difference (WMD), 0.61; 95 % confidence interval (CI), 0.16-1.06]. Eight trials (406 patients) that reported changes in BMD at the femoral neck also showed improved outcomes after treatment with bisphosphonates (WMD, 0.06; 95 % CI, 0.03-0.09). Bisphosphonates improve BMD at the lumbar spine and femoral neck after 12 months in renal-transplant recipients.
我们对双膦酸盐预防肾移植受者骨质减少的随机对照试验（RCT）进行了系统评价。12个月后，双膦酸盐可提高腰椎和股骨颈的骨密度。然而，需要更多设计良好的随机对照试验来确定最佳治疗策略。骨质减少-骨质疏松综合征是肾移植的一种骨并发症。双膦酸盐、降钙素和维生素D类似物可用于预防或治疗肾移植后的骨质疏松症或骨质流失。然而，目前尚无广泛认可的预防糖皮质激素诱导的骨质疏松症的策略。本研究旨在评估现有证据，以指导有针对性地使用双膦酸盐来减少肾移植受者的骨质疏松症和骨质流失。我们在Cochrane对照试验中央注册库、PubMed和EMBASE中检索了双膦酸盐用于肾移植后骨质疏松症或骨质流失的随机对照试验。共识别出352篇摘要，其中55篇被考虑进行评估，9篇纳入最终分析。主要结局指标是12个月后腰椎和股骨颈骨密度（BMD）的变化。由两名研究者独立进行数据提取。双膦酸盐治疗后腰椎骨密度得到改善[9项试验；418例患者；加权平均差（WMD），0.61；95%置信区间（CI），0.16 - 1.06]。8项报告股骨颈骨密度变化的试验（406例患者）也显示双膦酸盐治疗后结局得到改善（WMD，0.06；95%CI，0.03 - 0.09）。双膦酸盐可使肾移植受者在12个月后腰椎和股骨颈的骨密度得到改善。
