Do bisphosphonates and RANKL inhibitors alter the progression of coronary artery calcification? A systematic review
Publication Details
Saunders, S.,
Chaudhri, K.,
McOrist, N.,
Gladysz, K.,
Gnanenthiran, S. R.,
&
Shalaby, G.
(2024).
Do bisphosphonates and RANKL inhibitors alter the progression of coronary artery calcification? A systematic review.
BMJ Open, 14 (9).
Abstract
Objectives: To determine whether bisphosphonates and NF-κB ligand (RANKL) inhibitors delay coronary artery calcification (CAC).
Design: A systematic review was conducted. Data sources MEDLINE, EMBASE and CENTRAL.
Eligibility criteria: Longitudinal studies investigating CAC progression in adults (>18 years) taking either a bisphosphonate or denosumab compared with those who did not.
Data extraction and synthesis: Study and participant characteristics, and primary outcome (∆CAC from baseline to follow-up) were extracted. The Risk Of Bias In Non-Randomised Studies-of Interventions (ROBINS-I) and Risk-of-Bias Tool for Randomised Trials (RoB2) tools were used to assess the risk of bias for observational and randomised controlled trials (RCTs), respectively. Outcome measures were reported.
Results: Four observational studies and one RCT (n=377) were included. Three studies solely reported the effect of bisphosphonates on ∆CAC; one study (n=56) demonstrated a statistically significant CAC reduction in the intervention group (−372 mm3 /year) compared with control (+159mm3 /year) (p3 /year) versus control (+2220mm3 /year), however, no p value comparing groups was reported. One study (n=115) found no statistically significant difference between intervention and control. One study (n=42) exclusively investigated the effect of RANKL on ∆CAC; there was a statistically significant reduction in CAC at 6-month follow-up between intervention (−133±124 modified Agatston unit (AU)) and control (+188±72 modified AU), p=0.03. One study (n=150) compared both bisphosphonates and denosumab to control and found no statistically significant difference between either intervention group and control over 24 months. Meta-analysis was not performed due to limited, heterogeneous studies.
Conclusions: There is insufficient evidence supporting the correlation between bisphosphonate or RANKL inhibitor use and CAC progression. Further research is warranted.
Keywords
Coronary Artery Disease - drug therapy, Diagnostic imaging, cardiovascular imaging, RANK Ligand, Lipid disorders, Vascular Calcification
Link to Publisher Version (URL)
