Abstract
IntroductionThe 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 MethodsA 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.ResultsSix 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.ConclusionsThis 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.
Highlights
The overall effect of pamidronate on bone mass density (BMD) in the early renal transplant period varies considerably among studies
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 [21.84, 8.90])
Summary
The overall effect of pamidronate on bone mass density (BMD) in the early renal transplant period varies considerably among studies. Pamidronate significantly reduces the rate of bone reabsorption and turnover and increases BMD. Studies comparing pamidronate with traditional medicines, such as vitamin D and calcium, demonstrated pamidronate’s effectiveness in protecting against early post-transplant bone loss [6,7]. Overall efficacy of pamidronate on bone loss during the early period of transplantation varies considerably across studies [6,7,8,9]. The safety of pamidronate on graft function in posttransplant recipients is not completely clear, Lee S [10] has reported that pamidronate could attenuate post-renal transplant bone loss without leading to renal dysfunction.
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