Risks of serious adverse events and kidney injury in patients treated with ibandronate: A systematic review and meta-analysis.

Abstract

Several reports suggest that adverse events caused by ibandronate are less serious than those associated with the other bisphosphonates. The purpose of this systematic review and meta-analysis was to determine whether ibandronate has low rates of serious adverse events and kidney injury. Randomized controlled trials were selected, and the study populations consisted of adult patients with osteoporosis. The primary outcome was all serious adverse events and the secondary outcome was kidney injury. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Nineteen studies were eligible for inclusion. No significant difference in the rate of serious adverse events or that of kidney injury was found between ibandronate and placebo or between ibandronate and other bisphosphonates. However, a sensitivity analysis, which excluded studies at "high risk" of detection bias, found that the risk of serious adverse events was significantly lower for ibandronate than for the other bisphosphonates (risk ratio 0.79, 95% confidence interval 0.66-0.94, p < 0.01). This finding was assessed as high-quality evidence when the GRADE criteria were applied. Only five studies (26%) reported kidney injury as an adverse event. Limited evidence was found to suggest that ibandronate may carry a lower risk of serious adverse events compared with other bisphosphonates. Further high-quality randomized controlled trials are needed to compare the risk of kidney injury associated with the various bisphosphonates.