Pharmacological Interventions for Osteoporosis in Kidney Transplant Recipients: A Systematic Review and Meta-analysis
- 1Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
- 2Division of Nephrology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Abstract
Rational & Objective: Osteoporosis is a common complication after kidney transplantation and contributes to fracture risk and morbidity among kidney transplant recipients (KTRs). However, the efficacy of pharmacological interventions for osteoporosis in this population remains uncertain. Study Design: Systematic review and meta-analysis. Setting & Participants: KTRs. Selection Criteria for Studies: PubMed, Scopus, and the Cochrane Library were searched through December 2024 for randomized controlled trials evaluating pharmacological treatments’ effects on bone turnover markers, bone mineral density (BMD), and fracture incidence in KTRs. Data Extraction: Three independent reviewers extracted study characteristics, type of pharmacological interventions and comparators, and outcomes, including bone turnover markers, BMD, and fracture rates. Analytical Approach: A random-effects model was used to calculate weighted mean differences (WMD) for continuous outcomes and relative risks for categorical outcomes. Results: A total of 33 randomized controlled trials (2,623 KTRs) were included in this meta-analysis. Pharmacological treatment was not associated with significant changes in parathyroid hormone, bone alkaline phosphatase, and osteocalcin levels. In subgroup analysis, only active vitamin D showed a significant reduction in parathyroid hormone levels (WMD –25.18 pg/mL [–32.59 to –17.77]). Interestingly, pharmacological therapy significantly improved BMD at lumbar spine (WMD 0.04 g/cm 2 [0.00 to 0.08]; P = 0.04), radius (WMD 0.14 g/cm 2 [0.08-0.19]; P < 0.001), and femoral neck (WMD 0.05 g/cm 2 [0.03-0.07]; P < 0.001). However, no significant improvement in BMD was observed at the hip (WMD 0.03 g/cm 2 [–0.01 to 0.07]; P = 0.12). Furthermore, there was no statistically significant reduction in fracture risk (RR 0.38 [0.14-1.01]; P = 0.05). Limitations: Significant clinical and statistical heterogeneity (I 2 ) because of varied pharmacological agents, initiation timing, and recipient characteristics. Conclusions: Pharmacological interventions for osteoporosis in KTRs significantly improved BMD at several skeletal sites, particularly radius site. However, a nonsignificant trend toward reduced fracture incidence was observed. Plain-Language Summary: Osteoporosis is common and clinically important complications among kidney transplant recipients resulting in increased risk of fracture. Bone loss is more pronounced in the first year after kidney transplantation because of pre-existing chronic kidney disease–bone mineral disease and exposure to high dose of glucocorticoid. However, the efficacy of pharmacological therapy of osteoporosis in this population remained uncertain. This systematic review and meta-analysis of 33 randomized trials evaluated treatments for osteoporosis in kidney transplant recipients. Although no significant changes were observed in bone turnover biomarkers, pharmacological therapy significantly increased bone mineral density at the lumbar spine, radius, and femoral neck. Despite these improvements, fracture data remains limited and does not support a definitive conclusion regarding fracture reduction.
Related
- Renal Transplantation in Recipients With Modified Lower Urinary Tract: A Systematic Review and Implications for Adult Transplant Practice
- Peri-transplant eculizumab for preventing antibody-mediated rejection in kidney transplant recipients at high immunologic risk: a systematic review with design-stratified evidence synthesis
- Relevance‐Based Score for MIPD Model Selection: Systematic Review and External Evaluation of popPK Tacrolimus Models in Adult Transplant Recipients
- Home-based non-pharmacological interventions for cognition and diabetes self-management in adults with type 2 diabetes: a systematic review
- A systematic review and meta-analysis of the effects of non-pharmacological interventions in improving psychological status and sleep quality among hemodialysis patients
BibTeX
@article{wipattanakitcharoen2026pharmacological,
title = {{Pharmacological Interventions for Osteoporosis in Kidney Transplant Recipients: A Systematic Review and Meta-analysis}},
author = {Aschariya Wipattanakitcharoen and Tanun Ngamvichchukorn and Sirinatta Prachathai and Kullaya Takkavatakarn and Kearkiat Praditpornsilpa and Paweena Susantitaphong},
journal = {Kidney medicine},
year = {2026},
month = sep,
doi = {10.1016/j.xkme.2026.101537},
url = {https://europepmc.org/article/PMC/PMC13722076},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pharmacological Interventions for Osteoporosis in Kidney Transplant Recipients: A Systematic Review and Meta-analysis
AU - Aschariya Wipattanakitcharoen
AU - Tanun Ngamvichchukorn
AU - Sirinatta Prachathai
AU - Kullaya Takkavatakarn
AU - Kearkiat Praditpornsilpa
AU - Paweena Susantitaphong
PY - 2026
DA - 2026/09/17
JO - Kidney medicine
DO - 10.1016/j.xkme.2026.101537
UR - https://europepmc.org/article/PMC/PMC13722076
AB - Rational & Objective: Osteoporosis is a common complication after kidney transplantation and contributes to fracture risk and morbidity among kidney transplant recipients (KTRs). However, the efficacy of pharmacological interventions for osteoporosis in this population remains uncertain. Study Design: Systematic review and meta-analysis. Setting & Participants: KTRs. Selection Criteria for Studies: PubMed, Scopus, and the Cochrane Library were searched through December 2024 for randomized controlled trials evaluating pharmacological treatments’ effects on bone turnover markers, bone mineral density (BMD), and fracture incidence in KTRs. Data Extraction: Three independent reviewers extracted study characteristics, type of pharmacological interventions and comparators, and outcomes, including bone turnover markers, BMD, and fracture rates. Analytical Approach: A random-effects model was used to calculate weighted mean differences (WMD) for continuous outcomes and relative risks for categorical outcomes. Results: A total of 33 randomized controlled trials (2,623 KTRs) were included in this meta-analysis. Pharmacological treatment was not associated with significant changes in parathyroid hormone, bone alkaline phosphatase, and osteocalcin levels. In subgroup analysis, only active vitamin D showed a significant reduction in parathyroid hormone levels (WMD –25.18 pg/mL [–32.59 to –17.77]). Interestingly, pharmacological therapy significantly improved BMD at lumbar spine (WMD 0.04 g/cm 2 [0.00 to 0.08]; P = 0.04), radius (WMD 0.14 g/cm 2 [0.08-0.19]; P < 0.001), and femoral neck (WMD 0.05 g/cm 2 [0.03-0.07]; P < 0.001). However, no significant improvement in BMD was observed at the hip (WMD 0.03 g/cm 2 [–0.01 to 0.07]; P = 0.12). Furthermore, there was no statistically significant reduction in fracture risk (RR 0.38 [0.14-1.01]; P = 0.05). Limitations: Significant clinical and statistical heterogeneity (I 2 ) because of varied pharmacological agents, initiation timing, and recipient characteristics. Conclusions: Pharmacological interventions for osteoporosis in KTRs significantly improved BMD at several skeletal sites, particularly radius site. However, a nonsignificant trend toward reduced fracture incidence was observed. Plain-Language Summary: Osteoporosis is common and clinically important complications among kidney transplant recipients resulting in increased risk of fracture. Bone loss is more pronounced in the first year after kidney transplantation because of pre-existing chronic kidney disease–bone mineral disease and exposure to high dose of glucocorticoid. However, the efficacy of pharmacological therapy of osteoporosis in this population remained uncertain. This systematic review and meta-analysis of 33 randomized trials evaluated treatments for osteoporosis in kidney transplant recipients. Although no significant changes were observed in bone turnover biomarkers, pharmacological therapy significantly increased bone mineral density at the lumbar spine, radius, and femoral neck. Despite these improvements, fracture data remains limited and does not support a definitive conclusion regarding fracture reduction.
SN - 2590-0595
ER -