Osteoporos Sarcopenia.  2024 Jun;10(2):47-53. 10.1016/j.afos.2024.05.004.

Monoclonal antibodies in patients with osteoporosis and renal insufficiency: An updated systematic review and meta-analysis

• Defante ML
• Alzogaray V
• Celso DSG
• Torres LA
• Bearse M
• Lopes ACFMdM

• KMID: 2557454
• DOI: http://doi.org/10.1016/j.afos.2024.05.004

Abstract

Objectives
There are challenges for the treatment of osteoporosis in patients with kidney failure and monoclonal antibodies (MAb) might be a suitable therapy. However, the efficacy and safety of MAb among patients with osteoporosis and renal insufficiency remains unclear.
Methods
We systematically searched PubMed, Embase, and Cochrane Central for studies evaluating the efficacy and safety of the use of MAb in patients with osteoporosis and renal insufficiency. We pooled risk ratios (RR) and 95% confidence intervals (CI) for binary outcomes. Mean difference (MD) was used for continuous outcomes.
Results
We included 5 studies with 33,550 patients. MAb therapy decreased the risk of vertebral fractures (RR 0.32; 95% CI 0.26–0.40; P < 0.01) when compared to placebo and no statistical difference was found when comparing to bisphosphonate (RR 0.71; 95% CI 0.49–1.03; P = 0.07). MAb therapy also decreased the risk of nonvertebral fractures (RR 0.79; 95% CI 0.69–0.91; P = 0.0009). Lumbar spine bone mineral density (BMD) was higher in the MAb therapy when compared to both placebo (MD 10.90; 95% CI 8.00–13.80; P < 0.01) and bisphosphonate (MD 7.66; 95% CI 6.19–9.14; P < 0.01). There was no statistically significant difference in the change of estimated glomerular filtration rate and in the incidence of hypocalcemia and serious adverse events between groups.
Conclusions
There were reductions in both vertebral and nonvertebral fracture risks, alongside improvements in BMD among patients with renal insufficiency treated with MAb.

Keyword

Osteoporosis; Renal insufficiency; Monoclonal antibodies; Denosumab; Romosozumab