Clinical efficacy and safety of pamidronate therapy on bone mass density in early post-renal transplant period: a meta-analysis of randomized controlled trials

PLoS One. 2014 Sep 29;9(9):e108106. doi: 10.1371/journal.pone.0108106. eCollection 2014.

Abstract

Introduction: The overall effect of pamidronate on bone mass density (BMD) in the early renal transplant period varies considerably among studies. The effects of pamidronate on graft function have not been determined.

Materials and methods: A comprehensive search was conducted in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase independently by two authors. Randomized controlled trials of pamidronate evaluating bone loss in the first year of renal transplantation were included. Methods reported in the "Cochrane Handbook for Systematic Reviews of Interventions 5.0.2" were used to evaluate changes of lumbar spine and femoral neck BMD, and serum creatinine, calcium and intact parathyroid hormone (iPTH) levels. Fixed or random effect models were used as appropriate.

Results: Six randomized trials evaluating 281 patients were identified. One hundred forty-four were treated with pamidronate and 137 were control patients. Administration of pamidronate was associated with significant reduction of bone loss in the lumbar spine, compared to the control group (standardized mean difference (SMD) = 24.62 [16.25, 32.99]). There was no difference between the pamidronate treated and control femoral neck BMD (SMD = 3.53 [-1.84, 8.90]). A significant increase in the serum creatinine level of the intervention group was seen, compared to the control group. The serum calcium and iPTH of the pamidronate and control groups were not different after 1 year (serum creatinine: SMD = -3.101 [-5.33, -0.89]; serum calcium: SMD = 2.18 [-0.8, 5.16]; serum iPTH: SMD = 0.06 [-0.19, 0.31]). Heterogeneity was low for serum calcium and iPTH and high for serum creatinine.

Conclusions: This meta-analysis demonstrated the beneficial clinical efficacy of pamidronate on BMD with no association with any alteration in graft function during the first year of renal transplantation. Significant heterogeneity precludes the conclusion of the relationship between serum creatinine and pamidronate.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Bone Density / drug effects*
  • Bone Density Conservation Agents / adverse effects
  • Bone Density Conservation Agents / pharmacology
  • Bone Density Conservation Agents / therapeutic use*
  • Diphosphonates / adverse effects
  • Diphosphonates / pharmacology
  • Diphosphonates / therapeutic use*
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation*
  • Pamidronate
  • Randomized Controlled Trials as Topic*
  • Spinal Fractures
  • Treatment Outcome

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Immunosuppressive Agents
  • Pamidronate

Grants and funding

This project is sponsored by the grants from the National Natural Science Foundation of China(81100532), the Science and Education Health Project of Jiangsu Province for important talent (RC2011055), “333 high level talents project” in Jiangsu province (2011 and 2013), Jiangsu province six talents peak from Department of human resources, social security office of Jiangsu Province of China (2010WSN-56 and 2011-WS-033), General program of Department of Health of Jiangsu Province of China(H2009907), and the Priority Academic Program Development of Jiangsu Higher Education Institutions (JX10231801). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.