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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/51285
Title: Effects of denosumab on bone metabolism and bone mineral density in kidney transplant patients: a systematic review and meta-analysis
Authors: Charat Thongprayoon
Prakrati Acharya
Narothama Reddy Aeddula
Aldo Torres-Ortiz
Tarun Bathini
Konika Sharma
Patompong Ungprasert
Kanramon Watthanasuntorn
Maria Lourdes Gonzalez Suarez
Sohail Abdul Salim
Wisit Kaewput
Jirat Chenbhanich
Michael A. Mao
Wisit Cheungpasitporn
Faculty of Medicine, Siriraj Hospital, Mahidol University
University of Arizona
Indiana University School of Medicine Evansville
Phramongkutklao College of Medicine
MetroWest Medical Center
Mayo Clinic
University of Mississippi Medical Center
Bassett Medical Center
Keywords: Medicine
Issue Date: 1-Dec-2019
Citation: Archives of Osteoporosis. Vol.14, No.1 (2019)
Abstract: © 2019, International Osteoporosis Foundation and National Osteoporosis Foundation. Objective: The use of immunosuppressive agents, especially glucocorticoids, are associated with increased risks of bone loss in kidney transplant patients. Denosumab, a potent antiresorptive agent, has been shown to increase bone mineral density (BMD) in patients with CKD. However, its effects on bone metabolism and BMD in kidney transplant patients remain unclear. Methods: A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through April 2018 to identify studies evaluating denosumab’s effect on changes in bone metabolism and BMD from baseline to post-treatment course in kidney transplant patients. Study results were pooled and analyzed utilizing random-effects model. The protocol for this systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095055). Results: Five studies (a clinical trial and four cohort studies) with a total of 162 kidney transplant patients were identified. The majority of patients had a baseline eGFR ≥ 30 mL/min/1.73 m2. After treatment (≥ 6 to 12 months), there were significant increases in BMD with standardized mean differences (SMDs) of 3.26 (95% CI 0.88–5.64) and 1.83 (95% CI 0.43 to 3.22) for lumbar spine and femoral neck, respectively. There were also significant increases in T scores with SMDs of 0.92 (95% CI 0.58 to 1.25) and 1.14 (95% CI 0.17 to 2.10) for lumbar spine and femoral neck, respectively. After treatment, there were no significant changes in serum calcium (Ca) or parathyroid hormone (PTH) from baseline to post-treatment course (≥ 6 months) with mean differences (MDs) of 0.52 (95% CI, − 0.13 to 1.16) mmol/L and − 13.24 (95% CI, − 43.85 to 17.37) ng/L, respectively. The clinical trial data demonstrated more asymptomatic hypocalcemia in the denosumab (12 episodes in 39 patients) than in the control (1 episode in 42 patients) group. From the cohort studies, the pooled incidence of hypocalcemia following denosumab treatment was 1.7% (95% CI 0.4 to 6.6%). All reported hypocalcemic episodes were mild and asymptomatic, but the majority of patients required Ca and vitamin D supplements. Conclusion: Among kidney transplant patients with good allograft function, denosumab effectively increases BMD and T scores in the lumbar spine and femur neck. From baseline to post-treatment, there are no differences in serum Ca and PTH. However, mild hypocalcemia can occur following denosumab treatment, requiring monitoring and titration of Ca and vitamin D supplements.
URI: http://repository.li.mahidol.ac.th/dspace/handle/123456789/51285
metadata.dc.identifier.url: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85062721278&origin=inward
ISSN: 18623514
18623522
Appears in Collections:Scopus 2019

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