Bone Anabolic Treatment in Patients With Chronic Kidney Disease: A Systematic Review.

BACKGROUND

Chronic kidney disease (CKD) associated osteoporosis leads to an increased risk of bone fracture in patients with CKD. Evidence on the efficacy and safety of anti-osteoporotic medications is limited for this group. This systematic review aimed to examine the efficacy and safety of anabolic parathyroid hormone (PTH) treatment in patients with CKD Stages 4-5D.

METHODS

MEDLINE, EMBASE and ClinicalTrials.gov were searched systematically for randomized controlled trials (RCTs) investigating teriparatide, natpara, or abaloparatide in adult patients with CKD Stages 4-5D, including kidney transplant recipients. The primary outcome was the change in bone mineral density (BMD) during follow-up measured at the lumbar spine (LS), femoral neck (FN) and total hip (TH). The secondary outcomes included bone turnover markers, fractures, histomorphometric results from bone biopsies and adverse events (AEs).

RESULTS

Two RCTs were included. A subgroup analysis of patients with CKD Stage 4 (n = 5) showed that teriparatide improved BMD at the LS and FN. Another trial (n = 61) in CKD Stage 5D showed significant BMD improvement at the TH compared to the control group. AEs were observed with higher frequency in the teriparatide-treated group.

CONCLUSION

Treatment with teriparatide seems to improve BMD in patients with CKD Stages 4-5D, but evidence on efficacy and safety is limited.

TRIAL REGISTRATION: PROSPERO: CRD42024527086.