Efficacy and Safety of Bisphosphonates for Osteoporosis or Osteopenia in Cardiac Transplant Patients: A Meta-Analysis

• Bisphosphonates effectively reduced the loss of bone mass in vertebral BMD after cardiac transplantation.
• Bisphosphonates reduced femoral neck BMD after cardiac transplantation.
• No bisphosphonate treatment–related serious adverse reactions were found in the patients.

BackgroundAfter cardiac transplantation (CTP), the loss of bone mass is accelerated and there is an increased risk for bone fractures. Bisphosphonates are commonly used for preventing loss of bone mass after CTP. However, no systematic evaluation of the treatment efficacy of bisphosphonates after CTP has been reported. The aim of this meta-analysis was to assess the effectiveness and safety of bisphosphonates for osteoporosis or osteopenia after CTP.MethodsAn electronic database search including Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies up to March 2015. We included randomized controlled trials (RCTs) and nonrandomized prospective comparative studies that were concerned with bisphosphonates for osteoporosis after CTP. Statistical analyses were conducted with the use of Review Manager 5.1.6.ResultsThree RCTs and 3 nonrandomized prospective studies involving 425 participants were included. Eight and 12 months after CTP, compared with the control groups, vertebral bone mineral density (BMD) in patients treated with bisphosphonates was ∼0.06 g/cm2 higher than in control patients (weighted mean difference [WMD], 0.06 g/cm2; 95% CI, 0.03–0.08 g/cm2; P < .0001). The loss of femoral neck BMD was 0.03 g/cm2 lower in patients treated with bisphosphonates than in control patients; however, this difference was not statistically significant (WMD, 0.03 g/cm2; 95% CI, 0–0.05 g/cm2; P = .06). No bisphosphonate treatment–related serious adverse reactions were found in the patients.ConclusionsIn the early stage after CTP, bisphosphonates effectively reduced the loss of bone mass, especially in vertebral BMD.