Use of Bisphosphonates in Chronic Kidney Disease

Abstract

The primary goal of treatment for post-menopausal osteoporosis (PMO) is reduction in fracture risk. Therefore, bisphosphonates (BF) are the most commonly used drugs for the treatment of osteoporosis. Because of their urinary elimination, bisphosphonates must be carefully administered in chronic kidney disease (CKD) patients. Renal toxicity seems different among these compounds, and it is basically due to their protein binding and the average lifespan of renal tissues. In practice, renal toxicity has been associated with infusion speed and excessive dosage. Treatment decisions are more difficult with stage 4 and especially stage 5 CKD who had fragility fractures. In spite of this, bisphosphonates can safely be used at stage to 1 - 3 CKD stages, haemodialysis and after the kidney transplant. When bisphosphonates are given stage 4 CKD patients it seems reasonable to reduce the dose to 50%. There are few data on the efficacy (reduction in fracture risk) or safety of any BF in patients with stage 5 CKD.




doi:10.4021/wjnu5e