Abstract: SA-PO652
Efficacy of Teriparatide and Denosumab on Bone Mineral Density in Dialysis Patients: A Meta-Analysis
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Sanguankeo, Anawin, Johns Hopkins University, Baltimore, United States
- Upala, Sikarin, University of Chicago, Cooperstown, United States
Background
Teriparatide and denosumab are therapeutic agents proven to increase bone density and prevent fracture in patients with osteoporosis. Evidence of efficacy of these agents in end-stage renal disease (ESRD) is still lacking. This meta-analysis evaluated the effect of Teriparatide and denosumab on bone mineral density (BMD) and biochemical testing in ESRD patients on dialysis.
Methods
We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published studies using denosumab or teriparatide in dialysis patients with low bone mass for at least six months. The primary outcome was BMD at the femoral neck, lumbar spine, and radius. The secondary outcome was parathyroid hormone (PTH), calcium, phosphorus, and bone-specific alkaline phosphatase (BSAP). A random-effects meta-analysis was performed to compare the change in outcome at baseline and after denosumab or teriparatide was given.
Results
Four studies using teriparatide were included in the meta-analysis of BMD. Overall, there was no significant change in BMD at the femoral neck (p=0.59), lumbar spine (p=0.05), or radius (p=0.23). There was also no significant change in calcium (p=0.33), phosphorus (p=0.23), PTH (p=0.46), and BSAP (p=0.86). Four studies using denosumab were included in the meta-analysis. There was a significant decrease in PTH with a standardized mean difference of 2.22 (95% CI: 0.13 to 4.31). No significant change in calcium (p=0.37), phosphorus (p=0.43), and BSAP (p=0.15) was found. There was not enough study to assess the effect on BMD.
Conclusion
Current evidence does not support the use of denosumab or teriparatide in dialysis patients with low bone mass. More studies are needed to evaluate efficacy and safety of these therapeutic agents for osteoporosis in this population.
Forest plot of comparison for Teriparatide and BMD at A) Femoral neck and B) Lumbar spine