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20/10/2021 - General information

Using bisphosphonates to treat osteoporosis in patients with severe renal disease affects disease progression

Bisphosphonates are first-line treatment for preventing fractures in patients with osteoporosis. However, their use is contraindicated or should be approached with caution in patients with chronic kidney disease (CKD), mainly due to a lack of information on their safety and efficacy. A recent study in which researchers from British and Spanish universities and institutions collaborated, with the participation of researchers from the CIBER on Frailty and Healthy Ageing (CIBERFES) and the Hospital del Mar Institute of Medical Research (IMIM-Hospital del Mar), specifically addresses the safety of the use of these drugs, determining a moderate increase, 15%, in the risk of CKD progression associated with the use of bisphosphonates.

This is why the researchers warn of the importance of considering whether the stage of kidney failure is severe before prescribing the drug, as "It could worsen kidney function so that alternative treatments should be sought", as they state in the study published in the Journal of Bone and Mineral Research.

"This work makes a significant contribution because of the paucity of existing data. We must say that, reassuringly, we found no excess risk of acute kidney injury, gastrointestinal events, or hypocalcaemia with bisphosphonate use. Nevertheless, these results should be considered in terms of CKD stage progression, and we should continue to use bisphosphonates with caution in this population", adds CIBERFES researcher, coordinator of the Musculoskeletal Research Group at the IMIM-Hospital del Mar and head of the Internal Medicine Department at Hospital del Mar, Dr. Xavier Nogués.

The research was carried out using electronic primary care records from two series, CPRD GOLD (1997-2016) and SIDIAP (2007-2015), linked to hospital registries in the United Kingdom and Catalonia, respectively. The analyses included nearly 4,000 bisphosphonate users with at least two eGFR measurements of less than 45 ml/min/1.73 m2, matched with PS for more than 15,000 non-users.

CKD and osteoporosis

Moderate to severe chronic kidney disease (CKD) (stages 3 to 5) affects up to 2.8 million people in the UK and 2.7 million people in Spain. CKD is associated with low bone mass and therefore increasing severity of this disease is associated with an increased fracture risk. Although bisphosphonates are first-line anti-osteoporosis treatments for fracture prevention, their use is contraindicated, or they should be used with caution in patients with an estimated glomerular filtration rate (eGFR) of less than 30 ml/min/1.73 m2.

The most recent guidelines from the Kidney Disease Outcomes Quality Initiative state that potential renal progression, severity of any biochemical abnormalities, fracture risk, and CKD-related bone and mineral disorders should be considered when deciding whether to prescribe bisphosphonates.

World Osteoporosis Day

Osteoporosis is a bone metabolism disease characterised by a decrease in bone mass and deteriorated bone architecture, leading to bone fragility with a consequently increased risk of fractures. It is estimated that one in five men and one in three women over the age of 50 are likely to have an osteoporotic fracture. The most common fractures occur in the spine, wrist and hip. However, today this disease can be prevented, diagnosed and controlled.

Today, 20 October, is World Osteoporosis Day, a date that serves to raise awareness of the diagnosis and treatment of this disease, which can be prevented by strengthening bones at an early age, so that the risk of suffering osteoporosis in adulthood can be reduced by up to 50%.

Reference article:

Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease: A Binational Cohort Analysis

Danielle E Robinson, M Sanni Ali, Natalia Pallares, Cristian Tebé, Leena Elhussein, Bo Abrahamsen, Nigel K Arden, Yoav Ben-Shlomo, Fergus J Caskey, Cyrus Cooper, Daniel Dedman, Antonella Delmestri, Andrew Judge, María José Pérez-Sáez, Julio Pascual, Xavier Nogues, Adolfo Diez-Perez, Victoria Y Strauss, M Kassim Javaid, Daniel Prieto-Alhambra

https://pubmed.ncbi.nlm.nih.gov/33373491/

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