CDSR: In patients with stage 3-5D chronic kidney disease, the comparison of drug intervention with placebo, no treatment or conventional care for osteoporosis.

Background: Chronic kidney disease (CKD) is an independent risk factor for osteoporosis, which is more common in patients with CKD than in patients without CKD
.

Although some drugs have been used to effectively treat osteoporosis in the general population, it is not clear whether they are also effective and safe for CKD patients who have altered systemic minerals and bone metabolism

Chronic kidney disease (CKD) is an independent risk factor for osteoporosis and is more common in patients with CKD than in patients without CKD

Objective: To evaluate the effectiveness and safety of drug intervention in the treatment of osteoporosis in patients with CKD 3-5 and dialysis (5D)
.

Selection criteria: Randomized controlled trials comparing any anti-osteoporosis drug with placebo, no treatment or routine care of osteoporosis patients and CKD stage 3-5D
.

Data collection and analysis: The main results are the incidence of fractures at any site, bone density (BMD; dual-energy x-ray absorptiometry (DXA) measurement of femoral neck, total hip, lumbar spine and distal radius, death due to various reasons, and bad Incident rate, quality of life (QoL)
.

The random effects model was used to obtain a summary estimate of the effect.

Main results:

Seven studies involving 9164 osteoporosis and CKD 3-5D patients met the inclusion criteria; all participants were postmenopausal women
.

Five studies included patients with stage 3-4 CKD, and two studies included patients with stage 5 or 5D CKD

In patients with CKD stage 3-4, anti-osteoporosis drugs can reduce the risk of vertebral fractures (RR 0.
52, 95% CI 0.
39 ~ 0.
69; low certainty evidence)
.

Anti-osteoporosis drugs may have little or no effect on clinical fracture risk (RR 0.

In patients with severe CKD stage 5 or 5D, whether anti-osteoporosis drugs can reduce the risk of clinical fracture is uncertain (RR 0.
33, 95% CI 0.
01 to 7.
87; very low certainty evidence)
.

Whether anti-osteoporosis drugs improve femoral neck bone mineral density is uncertain because the certainty of this evidence is very low (MD 0.

Conclusion: In patients with CKD stage 3-4, anti-osteoporosis drugs may reduce the risk of vertebral fractures
.

In the moderately certain evidence, anti-osteoporosis drugs have little or no effect on the risk of clinical fractures and adverse events

In patients with CKD stage 3-4, anti-osteoporosis drugs may reduce the risk of vertebral fractures.

Hara T, Hijikata Y, Matsubara Y, Watanabe N, Pharmacological interventions versus placebo, no treatment or usual care for osteoporosis in people with chronic kidney disease stages 3-5D.

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