Global and regional prevalence of osteoporosis in kidney transplant recipients: a systematic review and meta-analysis

Abstract

Kidney transplant recipients (KTRs) are at a heightened risk of low bone density and fractures. This study sought to determine the overall prevalence of osteoporosis in KTRs. Published observational studies and those with a baseline report on osteoporosis were evaluated in databases such as PubMed, Scopus, Science Direct, Web of Science, and EMBASE, in addition to Google Scholar from January 1, 2000, to January 1, 2024. The methodological quality of the included studies was rigorously assessed using the JBI Critical Appraisal checklist. Heterogeneity across primary study results was evaluated using the I-square index, while publication bias was scrutinized using Egger's test and funnel plots. Statistical analyses were carried out using Stata software Ver. 11. After conducting searches across multiple databases, a total of 136 primary studies were ultimately included. The prevalence of osteoporosis in specific skeletal areas is as follows: 20% (95% CI 18-23, n = 67) in the lumbar region, 23% (95% CI 19-26, n = 53) in the femoral neck, 15% (95% CI 11-19, n = 20) in the total hip, 29% (95% CI 10-49, n = 5) in the forearm, and 34% (95% CI 28-40, n = 6) in the ultradistal radius. Based on sex-specific rate in the existing literature, the prevalence is reported as 21% (95% CI 15-27, n = 16) in men and 28% (95% CI 20-35, n = 16) in women. Our results for adult KTRs represent the high prevalence of osteoporosis which was highest in bone site rich in cortical content (e.g., ultradistal radius).

Keywords: Adult; Epidemiology; Kidney transplant recipients; Osteoporosis; Prevalence.

Fig. 1.

Flow diagram of included/excluded studies