Prevention of bone loss and fractures following solid organ transplantations: Protocol for a systematic review and network meta-analysis

PurposeSolid organ transplant (SOT) recipients can develop skeletal diseases caused by underlying conditions and the use of immunosuppressants. As a result, SOT recipients are at risk for decreased bone mineral density (BMD) and increased fracture incidences. We propose a network meta-analysis (NMA) that incorporates all available RCT data to provide the most comprehensive ranking of antiresorptive interventions according to their ability to decrease fracture incidences and increase BMD in SOT recipients. MethodsWe will search MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL and Chinese literature sources for RCTs, and we will include adult SOT recipients who took antiresorptive therapies starting at the time of transplant with relevant outcomes. We will perform title and full-text screening as well as data extraction in duplicate. We will report changes in BMD as weighted or standardized mean differences, and fracture incidences as risk ratios. We will use SUCRA scores to provide rankings of interventions, and we will examine the quality of evidence using risk of bias and CINeMA. ResultsThe results of this systematic review and network meta-analysis will be published in a peer-reviewed journal. ConclusionsTo our knowledge, this systematic review and network meta-analysis will be the most comprehensive quantitative analysis regarding the management of bone loss and fractures in SOT recipients. Our analysis should be able to provide physicians and patients with an up-to-date recommendation for pharmacotherapies in reducing incidences of bone loss and fractures associated with SOT. CONFLICT OF INTERESTJiawen Deng, and Wenteng Hou declare that they have no conflict of interest. MINI ABSTRACTWe propose a network meta-analysis investigating the use of antiresorptive interventions to prevent bone loss and fractures in solid organ transplant (SOT) recipients. We aim to provide a comprehensive ranking of antiresorptive therapies in terms of their ability to increase bone mineral density and decrease fracture incidence in SOT recipients.