According to research, the study was conducted to evaluate the effect of different bisphosphonates on the efficacy and safety of renal transplant patients through the online Metasystem. 

Bone metabolism disorder is a common complication in patients after renal transplantation. It was shown that bisphosphonates could increase bone density in renal transplant patients, and the specific regimen is not yet clear. Hence the study was conducted to know the efficacy of bisphosphonates.

A systematic search was performed on randomized controlled trials of the use of bisphosphonates after renal transplantation in adults. The search period was from Jianku to April 2017. 

The main result is the change in bone mineral density. Document quality is assessed through the Cochrane Systematic Review Manual. Paired meta-analysis was performed using a random effects model, and a Bayesian model was used for meta-analysis of meta-analysis and the level of evidence was evaluated. 

A total of 21 randomized controlled trials were included in this article, including six different bisphosphonates, totaling 1332 patients. Lumbar BMD: Assessment of relative changes, with the exception of clodronate, the remaining groups were superior to calcium alone (MD, 2.85; 95% CrI, -3.78 to 10.36). 

Compared to calcium combined with vitamin D, the addition of pamidronate or alendronate was superior (MD, 6.34; 95% CrI, 2.59 to 11.01; MD, 6.16; 95% CrI, 0.54 to 13.24). The pamidronate group was superior to the clodronate group (MD, 9.84; 95% CrI, 1.06-19.70). To assess the absolute change, zoledronate combined with calcium was superior to the calcium alone group (MD, 0.06; 95% CrI, 0.00 to 0.12). 

Femoral Neck Bone Mineral Density: Compared to calcium alone, pamidronate or ibandronate combined with calcium was more beneficial to increase relative BMD (MD, 7.02; 95% CrI, 0.30 to 13.29; MD, 7.30 95% CrI, 0.32 to 14.22). To assess absolute change, ibandronate combined with calcium was the best and ranked first. 

The Network meta-analysis suggested that new-generation bisphosphonates such as ibandronate were more favorable in KTRs to improve BMD. However, the conclusion should be treated with caution due to indirect comparisons.