Comparison 1. Bisphosphonate versus placebo or no treatment.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Fracture	13	765	Risk Ratio (M‐H, Random, 95% CI)	0.62 [0.38, 1.01]
2 Acute graft rejection	7	470	Risk Ratio (M‐H, Random, 95% CI)	0.70 [0.55, 0.89]
3 Death	10		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
3.1 All causes	10	597	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.34, 2.80]
3.2 Cardiovascular	3	150	Risk Ratio (M‐H, Random, 95% CI)	0.33 [0.01, 7.58]
4 Musculoskeletal disorders	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
4.1 Bone pain	3	153	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.04, 0.93]
4.2 Spinal deformity	1	72	Risk Ratio (M‐H, Random, 95% CI)	0.58 [0.26, 1.31]
5 Bone mineral density [g calcium/cm2]	13		Mean Difference (IV, Random, 95% CI)	Subtotals only
5.1 Vertebral	13	579	Mean Difference (IV, Random, 95% CI)	0.04 [‐0.01, 0.08]
5.2 Femoral neck	12	520	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.03, 0.07]
6 Presence of low bone turnover seen on bone histomorphometry	2	33	Risk Ratio (M‐H, Random, 95% CI)	1.67 [0.76, 3.64]
7 Serum parathyroid hormone	11	590	Mean Difference (IV, Random, 95% CI)	0.70 [‐0.62, 2.02]
8 Vascular calcification score	2	74	Std. Mean Difference (IV, Random, 95% CI)	‐0.00 [‐0.46, 0.46]
9 Proteinuria (urinary protein:creatinine ratio)	1		Mean Difference (IV, Random, 95% CI)	Totals not selected
10 Graft loss	7	403	Risk Ratio (M‐H, Random, 95% CI)	0.65 [0.27, 1.60]
11 Serum creatinine	12	504	Mean Difference (IV, Random, 95% CI)	2.18 [‐7.78, 12.15]
12 eGFR [mL/min/1.73 m2]	2	82	Mean Difference (IV, Random, 95% CI)	‐0.97 [‐17.62, 15.67]
13 Gastro‐oesophageal disorder	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected
14 Gastrointestinal symptoms	2		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected
14.1 Nausea	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
14.2 Vomiting	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
14.3 Diarrhoea	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
15 Hypercalcaemia	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected
16 Hypocalcaemia	4	207	Risk Ratio (M‐H, Random, 95% CI)	5.59 [1.00, 31.06]