Management of Osteoporosis in Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) patients with coexisting osteoporosis are becoming common. Many of the therapeutic agents used to treat osteoporosis are known to be affected by the renal function. It is generally thought that osteoporosis in G1 to G3 CKD patients can be treated as in non-CKD patients with osteoporosis. In stage 4 or more advanced CKD patients and CKD patients on dialysis with osteoporosis, however, bisphosphonates must be used with caution, bearing in mind the potential development of such disorders as adynamic bone disease. The use of vitamin D preparations in low doses is relatively safe. In postmenopausal women, raloxifene must be administered with caution. When using denosumab, the serum calcium concentrations should be monitored carefully to prevent the development of hypocalcemia, and active vitamin D preparations should be administered concomitantly. The present article provides an overview of the management of osteoporosis in CKD patients.

Calcium-Phosphate Metabolism Disorders in Patients with Renal Failure Clinical Significance, Diagnosis and Treatment

“…No signi cant difference was observed between controls and participants in the therapeutic group in terms of renal function indicators (change in serum creatinine levels for two years of follow-up), regardless of base value of GFR (respectively the CRF stage). Similar data were also reported in the safety assessment of alendronate -the drug did not result in worsening of renal function in patients with GFR 15 ml/min/1.73 m 2 [5]. The ef cacy and safety pro le of bisphosphonates for intravenous administration (ibandronate and zoledronic acid) was monitored with rst -third stage CRF patients.…”

“…Similar results were also seen with alendronate therapy. In addition, risedronate demonstrated a good safety pro le -5 mg of the drug per day over a period of more than two years was not associated with a signi cant change in serum creatinine [5]. No signi cant difference was observed between controls and participants in the therapeutic group in terms of renal function indicators (change in serum creatinine levels for two years of follow-up), regardless of base value of GFR (respectively the CRF stage).…”

“…In case of dual-energy X-ray absorptiometry (DEXA)proven osteoporosis in patients with mild to moderate CRF (stage 2-3), treatment is not different from that in menopausal women with normal renal function and drugs of choice are bisphosphonates (mainly alendronate and risedronate) as well as raloxifene, teriparatide and denosumab [5].…”

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

“…(20,64,(144)(145)(146) Denosumab is a monoclonal antibody that binds to the cytokine RANKL (receptor activator of nuclear factor kappa-B ligand), thereby inhibiting osteoclasts and functioning primarily as an antiresorptive. (20,64,149,150) Unlike bisphosphonates, denosumab is not incorporated into the bone matrix and its antiresorptive effects do not continue after treatment is discontinued; rapid transition to another therapy after discontinuation of denosumab is recommended to prevent the risk of fractures from subsequently increasing. (148) Denosumab is administered by subcutaneous injection every 6 months and is thought to be appropriate for patients with renal insufficiency, although any calcium deficiency, vitamin D deficiency, or secondary hyperparathyroidism should be resolved first and patients with severe insufficiency should be monitored for hypocalcemia.…”

“…(148) Denosumab is administered by subcutaneous injection every 6 months and is thought to be appropriate for patients with renal insufficiency, although any calcium deficiency, vitamin D deficiency, or secondary hyperparathyroidism should be resolved first and patients with severe insufficiency should be monitored for hypocalcemia. (20,64,149,150) Unlike bisphosphonates, denosumab is not incorporated into the bone matrix and its antiresorptive effects do not continue after treatment is discontinued; rapid transition to another therapy after discontinuation of denosumab is recommended to prevent the risk of fractures from subsequently increasing. (64,151) Depending on individual medical circumstances and other factors, the anabolic agents teriparatide, abaloparatide, and romosozumab may also be useful front-line therapies.…”