Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China.
Department of Oncology, The Fifth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, People's Republic of China.
Hemodial Int. 2023 Oct;27(4):352-363. doi: 10.1111/hdi.13098. Epub 2023 Jun 1.
The effects of denosumab on bone mineral density (BMD) and metabolism in patients with end-stage renal disease (ESRD) remain controversial. Hence, we performed a systematic review and meta-analysis of observational studies.
The MEDLINE, EMBASE, and Cochrane Library databases were searched in June 2022 to identify studies that evaluated the risk of denosumab-associated hypocalcemia and changes in bone metabolism, changes in BMD from baseline to post-treatment in patients with ESRD.
Twelve studies with 348 participants were included. The pooled incidence of hypocalcemia during denosumab treatment was 35.0% (95% confidence interval [CI], 25%-46%; I = 63.6%). There were no significant changes in either the serum calcium or phosphate levels from the baseline to post-treatment period; the mean differences were 0.04 mg/dL (95% CI, -0.12 to 0.20 mg/dL) and -0.39 mg/dL (95% CI, -0.89 to 0.12 mg/dL). We found significant changes in the alkaline phosphatase and parathyroid hormone levels; the standardized mean differences were -2.98 (95% CI, -5.36 to -0.59) and -3.12 (95% CI: -4.94 to -1.29), respectively. Denosumab may increase BMD, with mean differences of 9.10% (95% CI: 4.07%-14.13%) and 9.00% (95% CI: 5.93%-12.07%) for the femoral neck and lumbar spine, respectively.
Denosumab increased the BMDs of the lumbar spine and femoral neck in patients with ESRD. The onset of hypocalcemia must be carefully monitored during denosumab administration.
地舒单抗对终末期肾病（ESRD）患者的骨密度（BMD）和代谢的影响仍存在争议。因此，我们进行了一项观察性研究的系统回顾和荟萃分析。
我们于 2022 年 6 月检索了 MEDLINE、EMBASE 和 Cochrane 图书馆数据库，以确定评估地舒单抗相关低钙血症风险和骨代谢变化、ESRD 患者治疗后与基线相比 BMD 变化的研究。
纳入了 12 项研究，共 348 名参与者。地舒单抗治疗期间低钙血症的总发生率为 35.0%（95%置信区间 [CI]，25%-46%；I²=63.6%）。从基线到治疗后期间，血清钙或磷水平没有显著变化；平均差异分别为 0.04mg/dL（95%CI，-0.12 至 0.20mg/dL）和-0.39mg/dL（95%CI，-0.89 至 0.12mg/dL）。我们发现碱性磷酸酶和甲状旁腺激素水平有显著变化；标准化平均差异分别为-2.98（95%CI，-5.36 至-0.59）和-3.12（95%CI：-4.94 至-1.29）。地舒单抗可能会增加 BMD，股骨颈和腰椎的平均差异分别为 9.10%（95%CI：4.07%-14.13%）和 9.00%（95%CI：5.93%-12.07%）。
地舒单抗增加了 ESRD 患者腰椎和股骨颈的 BMD。在给予地舒单抗期间必须仔细监测低钙血症的发生。
