Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

Takuya Wakamatsu; Suguru Yamamoto; Koji Matsuo; Masatomo Taniguchi; Takayuki Hamano; Masafumi Fukagawa; Junichiro James Kazama

doi:10.1007/s00774-024-01500-y

Effectiveness of calcimimetics on fractures in dialysis patients with secondary hyperparathyroidism: meta-analysis of randomized trials

J Bone Miner Metab. 2024 Mar 27. doi: 10.1007/s00774-024-01500-y. Online ahead of print.

Authors

Takuya Wakamatsu¹, Suguru Yamamoto², Koji Matsuo³, Masatomo Taniguchi⁴, Takayuki Hamano^{5

6}, Masafumi Fukagawa⁷, Junichiro James Kazama⁸

Affiliations

¹ Department of Nephrology and Rheumatology, Niigata City General Hospital, Niigata, Japan.
² Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan. yamamots@med.niigata-u.ac.jp.
³ Division of Nephrology, Niigata Shirone General Hospital, Niigata, Japan.
⁴ Fukuoka Renal Clinic, Fukuoka, Japan.
⁵ Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
⁶ Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁷ Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
⁸ Division of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.

PMID: 38536478
DOI: 10.1007/s00774-024-01500-y

Abstract

Introduction: This study aimed to assess the effectiveness of calcimimetics in reducing the risk of fractures in dialysis patients with secondary hyperparathyroidism (SHPT).

Material and methods: A comprehensive literature search was conducted using PubMed, Embase, and Cochrane Library for articles published through December 9, 2023. The quality of each trial was evaluated using the Cochrane Collaboration tool. Meta-analysis was performed using a random-effects model, and effect measures across studies were synthesized. The risk ratio (RR) and 95% confidence interval (CI) were used to quantify the risk of fracture.

Results: We identified seven studies involving 6481 dialysis patients with SHPT. The administration of calcimimetics reduced fracture incidence compared to placebo or conventional treatment (RR: 0.50, 95% CI 0.29-0.88, p = 0.02). Calcimimetics demonstrated a low number needed to treat (NNT) to prevent an incident fracture (NNT: 47).

Conclusion: The use of calcimimetics offers a significant benefit in reducing the risk of fractures in patients undergoing dialysis with SHPT.

Keywords: Calcimimetics; Dialysis; Fracture; Meta-analysis; Parathyroid hormone.