Kahwaji Joseph M, Yang Su-Jau, Sim John J, Parke Chong Young, Lee Roland L
Department of Nephrology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Department of Research and Evaluation, Kaiser Foundation Hospitals, Pasadena, California.
Clin J Am Soc Nephrol. 2024 Nov 5;20(2):267-76. doi: 10.2215/CJN.0000000591.
Bisphosponate use may decrease the risk of fracture in patients receiving kidney transplant. Identifying those at risk of fracture after kidney transplant is critical.
Kidney transplant recipients are at higher risk of fractures compared with the general population. The use of bisphosphonates has been shown to increase bone mineral density after transplantation but has not been shown to lower fracture rates. In this study, we aim to determine whether exposure to bisphosphonates is associated with lower incidence of nonvertebral fractures after kidney transplantation.
We conducted a retrospective review for all Southern California Kaiser Permanente kidney transplant recipients with osteoporosis transplanted between 2000 and 2019. Baseline variables were collected. Those prescribed an oral bisphosphonate were compared with those who were not. The primary outcome was nonvertebral fracture. Chi-square test was used to evaluate categorical variables and Wilcoxon rank-sum test for continuous variables. Propensity scores were generated to balance covariates in the bisphosphonate and nonbisphosphonate groups. Cause-specific hazard and subdistribution (Fine–Gray) methods were performed for competing risk analysis. Death-censored graft survival was evaluated as a secondary outcome using standard Cox regression.
There were 489 patients included in the study, 203 of which were in the bisphosphonate group. The cause-specific hazard model suggested a 64% lower risk of nonvertebral fracture in the bisphosphonate group ( = 0.02). The Fine–Gray hazard model treating death as a competing risk did not show lower relative incidence of nonvertebral fracture. Bisphosphonate treatment was associated with lower death-censored graft failure ( = 0.002).
Bisphosphonate use after kidney transplantation may be associated with a lower risk of nonvertebral fracture after transplant. Bisphosphonate use in this study was also associated with lower death-censored graft failure. Caution is advised when interpreting these results given the retrospective nature of the study.
双膦酸盐的使用可能会降低肾移植患者的骨折风险。识别肾移植后有骨折风险的患者至关重要。
与普通人群相比，肾移植受者骨折风险更高。双膦酸盐的使用已被证明可提高移植后的骨矿物质密度，但尚未证明能降低骨折率。在本研究中，我们旨在确定接触双膦酸盐是否与肾移植后非椎骨骨折的发生率降低相关。
我们对2000年至2019年间在南加州凯撒医疗集团接受骨质疏松症肾移植的所有患者进行了回顾性研究。收集基线变量。将开具口服双膦酸盐的患者与未开具的患者进行比较。主要结局是非椎骨骨折。采用卡方检验评估分类变量，采用Wilcoxon秩和检验评估连续变量。生成倾向得分以平衡双膦酸盐组和非双膦酸盐组的协变量。采用特定病因风险和亚分布（Fine–Gray）方法进行竞争风险分析。使用标准Cox回归将死亡删失的移植物存活率作为次要结局进行评估。
本研究共纳入489例患者，其中203例在双膦酸盐组。特定病因风险模型表明，双膦酸盐组非椎骨骨折风险降低64%（P = 0.02）。将死亡视为竞争风险的Fine–Gray风险模型未显示非椎骨骨折的相对发生率降低。双膦酸盐治疗与较低的死亡删失移植物失败率相关（P = 0.002）。
肾移植后使用双膦酸盐可能与移植后非椎骨骨折风险降低相关。本研究中双膦酸盐的使用还与较低的死亡删失移植物失败率相关。鉴于本研究的回顾性性质，在解释这些结果时应谨慎。
