SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1569744
Effects of Anti-Osteoporotic Drugs in Patients with Chronic Kidney Disease: A Systemic Review and Network Meta-analysis of bone mineral density, clinical fracture rate and renal function
Provisionally accepted
- 1Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- 2Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
- 3Department of Orthopaedic Surgery, Spine Section and Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
- 4Kidney Research Center, Nephrology Department, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
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Objective: This systematic review and network meta-analysis investigated the effects of various antiosteoporotic drugs (AODs) on bone mineral density (BMD), estimated glomerular filtration rate (eGFR), and clinical fracture rate in patients with chronic kidney disease (CKD) and osteoporosis.We searched for relevant studies in PubMed, Embase, and Web of Science and included randomized controlled trials with any following outcomes of interest: clinical fracture rate, BMD, and eGFR. The effectiveness of different AODs was assessed by random-effects model network meta-analysis and ranked on the basis of P-scores. A total of seven studies involving 18,503 patients were included. Three AODs: sclerostin inhibitors, bisphosphonates and parathyroid hormone (PTH) analogs were associated with mild but significantly increased BMD at the lumbar spine, total hip, and femoral neck. In addition, sclerostin inhibitors (relative risk; RR:0.38, 95% CI: 0.23-0.62), bisphosphonates (RR:0.53, 95% CI: 0.30-0.92), denosumab (RR:0.58, 95% CI: 0.52-0.66), and PTH analogs (RR:0.68, 95% CI: 0.55-0.86) effectively reduced clinical fracture rates. AODs did not significantly affect eGFRs. Among the five AODs, according to P-score ranking, sclerostin inhibitors were the most effective in reducing clinical fracture risk, and PTH analogs resulted in the most favorable improvement in BMD. The five AODs had no significant effect on eGFR.We demonstrated that bisphosphonates, PTH analogs, denosumab, and sclerostin inhibitors can reduce clinical fracture risk in CKD patient's osteoporosis but with low to very low confidence of evidence. In clinical practice, sclerostin inhibitors and PTH analogs could result in the highest reduction in clinical fracture risk and improvement in BMD, respectively.
Keywords: Osteoporosis, Chronic Kidney Disease, Anti-osteoporotic drugs, bone mineral density, Fracture, Renal function
Received: 01 Feb 2025; Accepted: 30 May 2025.
Copyright: © 2025 Wung, Liu, Tsai and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tsung-Ting Tsai, Department of Orthopaedic Surgery, Spine Section and Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
Jia-Jin Chen, Kidney Research Center, Nephrology Department, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
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