Bone Anabolic Treatment in Patients With Chronic Kidney Disease: A Systematic Review.
Teriparatide may improve bone mineral density in patients with chronic kidney disease, but the evidence is limited and further research is needed.
Where it sits
this study against the rest of the abaloparatide (tymlos) corpusSummary and findings
This systematic review examined the efficacy and safety of anabolic parathyroid hormone treatments, including abaloparatide, in patients with chronic kidney disease (CKD) Stages 4-5D. Two randomized controlled trials were included, with one showing significant improvement in bone mineral density (BMD) at the total hip. Adverse events were reported more frequently in the treatment group.
Abstract
<h4>Background</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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.<h4>Conclusion</h4>Treatment with teriparatide seems to improve BMD in patients with CKD Stages 4-5D, but evidence on efficacy and safety is limited.<h4>Trial registration</h4>PROSPERO: CRD42024527086.
Background
This paper addresses the clinical question of how anabolic parathyroid hormone treatments affect bone health in patients with chronic kidney disease (CKD), a population at increased risk for osteoporosis and fractures. Prior studies have shown limited evidence regarding the efficacy of anti-osteoporotic medications in CKD patients. This systematic review aims to consolidate findings on the use of teriparatide, natpara, and abaloparatide in this specific patient group.
Methods
The study employed a systematic review design, searching MEDLINE, EMBASE, and ClinicalTrials.gov for randomized controlled trials (RCTs) involving adult patients with CKD Stages 4-5D, including kidney transplant recipients. The primary outcome measured was the change in bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip. Secondary outcomes included bone turnover markers, fractures, histomorphometric results, and adverse events.
Results
Two RCTs were included in the review. A subgroup analysis of patients with CKD Stage 4 (n=5) indicated improved BMD at the lumbar spine and femoral neck with teriparatide treatment. Another trial involving CKD Stage 5D patients (n=61) reported significant BMD improvement at the total hip compared to the control group.
Interpretation
The findings suggest that teriparatide may improve BMD in patients with CKD, particularly in Stages 4 and 5D. However, the effect sizes may not be clinically significant given the small sample sizes and limited number of studies. The higher frequency of adverse events in the teriparatide group raises concerns about safety. Overall, the limited evidence necessitates caution in drawing definitive conclusions regarding the efficacy and safety of these treatments in CKD patients.
Key findings
- n=5 patients with CKD Stage 4 showed improved BMD at lumbar spine and femoral neck with teriparatide.
- n=61 patients with CKD Stage 5D showed significant BMD improvement at total hip compared to control.
- Adverse events were observed with higher frequency in the teriparatide-treated group.
Limitations
- Only two RCTs included.
- Small sample size in subgroup analysis (n=5).
- Limited evidence on efficacy and safety.
- Higher frequency of adverse events in teriparatide group.