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Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 1 Vertebral fractures.
Figures and Tables -
Analysis 1.1

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 1 Vertebral fractures.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 2 Non‐vertebral fractures.
Figures and Tables -
Analysis 1.2

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 2 Non‐vertebral fractures.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 3 Total Fractures.
Figures and Tables -
Analysis 1.3

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 3 Total Fractures.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 4 Percent change in BMD, lumbar spine, DXA (Time‐points).
Figures and Tables -
Analysis 1.4

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 4 Percent change in BMD, lumbar spine, DXA (Time‐points).

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 5 Percent change in BMD, lumbar spine, DXA (End of study).
Figures and Tables -
Analysis 1.5

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 5 Percent change in BMD, lumbar spine, DXA (End of study).

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 6 Percent change in BMD, total hip / femur, DXA (Time‐points).
Figures and Tables -
Analysis 1.6

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 6 Percent change in BMD, total hip / femur, DXA (Time‐points).

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 7 Percent change in BMD, total hip/femur, DXA (End of study).
Figures and Tables -
Analysis 1.7

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 7 Percent change in BMD, total hip/femur, DXA (End of study).

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 8 Percent change in BMD, distal radius, SXA (Time‐points).
Figures and Tables -
Analysis 1.8

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 8 Percent change in BMD, distal radius, SXA (Time‐points).

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 9 Percent change in BMD, distal radius, SXA (End of study).
Figures and Tables -
Analysis 1.9

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 9 Percent change in BMD, distal radius, SXA (End of study).

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 10 Percent change in BMD, ultradistal radius, SXA.
Figures and Tables -
Analysis 1.10

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 10 Percent change in BMD, ultradistal radius, SXA.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 11 Bone pain.
Figures and Tables -
Analysis 1.11

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 11 Bone pain.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 12 Fever.
Figures and Tables -
Analysis 1.12

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 12 Fever.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 13 Withdrawals, due to adverse events.
Figures and Tables -
Analysis 1.13

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 13 Withdrawals, due to adverse events.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 14 Withdrawals, total.
Figures and Tables -
Analysis 1.14

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 14 Withdrawals, total.

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 15 Survival.
Figures and Tables -
Analysis 1.15

Comparison 1 Bisphosphonates versus control (without lung transplantation), Outcome 15 Survival.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 1 Vertebral fractures.
Figures and Tables -
Analysis 2.1

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 1 Vertebral fractures.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 2 Non‐vertebral fractures.
Figures and Tables -
Analysis 2.2

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 2 Non‐vertebral fractures.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 3 Total Fractures.
Figures and Tables -
Analysis 2.3

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 3 Total Fractures.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 4 Percent change in BMD, lumbar spine, DXA.
Figures and Tables -
Analysis 2.4

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 4 Percent change in BMD, lumbar spine, DXA.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 5 Percent change in BMD, femur, DXA.
Figures and Tables -
Analysis 2.5

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 5 Percent change in BMD, femur, DXA.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 6 Bone pain.
Figures and Tables -
Analysis 2.6

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 6 Bone pain.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 7 Withdrawals, due to adverse events.
Figures and Tables -
Analysis 2.7

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 7 Withdrawals, due to adverse events.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 8 Withdrawals, total.
Figures and Tables -
Analysis 2.8

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 8 Withdrawals, total.

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 9 Survival.
Figures and Tables -
Analysis 2.9

Comparison 2 Bisphosphonates versus control (with lung transplantation), Outcome 9 Survival.

Comparison 1. Bisphosphonates versus control (without lung transplantation)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Vertebral fractures Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 12 months

2

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 24 months

1

20

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Non‐vertebral fractures Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 12 months

2

60

Odds Ratio (M‐H, Fixed, 95% CI)

2.11 [0.18, 25.35]

2.2 24 months

1

20

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Total Fractures Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 12 months

2

60

Odds Ratio (M‐H, Fixed, 95% CI)

2.11 [0.18, 25.35]

3.2 24 months

1

20

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Percent change in BMD, lumbar spine, DXA (Time‐points) Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 6 months

4

101

Mean Difference (IV, Fixed, 95% CI)

4.61 [3.90, 5.32]

4.2 12 months

2

59

Mean Difference (IV, Fixed, 95% CI)

6.38 [5.21, 7.54]

4.3 24 months

1

19

Mean Difference (IV, Fixed, 95% CI)

5.70 [4.55, 6.85]

5 Percent change in BMD, lumbar spine, DXA (End of study) Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 End of study

4

92

Mean Difference (IV, Fixed, 95% CI)

5.90 [4.94, 6.87]

6 Percent change in BMD, total hip / femur, DXA (Time‐points) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 6 months

3

96

Mean Difference (IV, Random, 95% CI)

3.35 [1.63, 5.07]

6.2 12 months

2

59

Mean Difference (IV, Random, 95% CI)

4.84 [2.73, 6.96]

6.3 24 months

1

19

Mean Difference (IV, Random, 95% CI)

6.73 [5.51, 7.95]

7 Percent change in BMD, total hip/femur, DXA (End of study) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 End of study

3

87

Mean Difference (IV, Random, 95% CI)

4.58 [1.92, 7.24]

8 Percent change in BMD, distal radius, SXA (Time‐points) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 6 months

2

48

Mean Difference (IV, Random, 95% CI)

‐0.49 [‐2.42, 1.45]

8.2 12 months

1

18

Mean Difference (IV, Random, 95% CI)

0.32 [‐0.30, 0.94]

8.3 24 months

1

14

Mean Difference (IV, Random, 95% CI)

1.5 [0.41, 2.59]

9 Percent change in BMD, distal radius, SXA (End of study) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 End of study

2

42

Mean Difference (IV, Random, 95% CI)

0.01 [‐3.12, 3.14]

10 Percent change in BMD, ultradistal radius, SXA Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Bone pain Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Oral bisphosphonates

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 Intravenous bisphosphonates

3

60

Odds Ratio (M‐H, Fixed, 95% CI)

14.17 [3.64, 55.17]

11.3 All routes of bisphosphonate administration

4

108

Odds Ratio (M‐H, Fixed, 95% CI)

14.17 [3.64, 55.17]

12 Fever Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Oral bisphosphonates

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.2 Intravenous bisphosphonates

3

55

Odds Ratio (M‐H, Fixed, 95% CI)

12.64 [2.31, 69.11]

12.3 All routes of bisphosphonate administration

4

103

Odds Ratio (M‐H, Fixed, 95% CI)

12.64 [2.31, 69.11]

13 Withdrawals, due to adverse events Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 6 months

2

53

Odds Ratio (M‐H, Fixed, 95% CI)

3.95 [0.14, 108.09]

13.2 12 months

2

70

Odds Ratio (M‐H, Fixed, 95% CI)

7.35 [0.31, 173.13]

13.3 24 months

1

22

Odds Ratio (M‐H, Fixed, 95% CI)

7.35 [0.31, 173.13]

14 Withdrawals, total Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 6 months

2

53

Odds Ratio (M‐H, Fixed, 95% CI)

2.83 [0.39, 20.73]

14.2 12 months

2

70

Odds Ratio (M‐H, Fixed, 95% CI)

1.08 [0.31, 3.73]

14.3 24 months

1

22

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.07, 2.50]

15 Survival Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15.1 6 months

2

36

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.05, 16.39]

15.2 12 months

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

3.13 [0.12, 80.68]

15.3 24 months

1

22

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Bisphosphonates versus control (without lung transplantation)
Comparison 2. Bisphosphonates versus control (with lung transplantation)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Vertebral fractures Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 24 months

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Non‐vertebral fractures Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 24 months

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Total Fractures Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 24 months

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Percent change in BMD, lumbar spine, DXA Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 24 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Percent change in BMD, femur, DXA Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 24 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Bone pain Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 24 months

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Withdrawals, due to adverse events Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8 Withdrawals, total Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 24 months

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Survival Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

9.1 24 months

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Bisphosphonates versus control (with lung transplantation)