Osteoporosis management in patient with renal function impairment

Abstract

Aging is associated with decreases in bone quality and in glomerular filtration. Consequently, osteoporosis and chronic kidney disease (CKD) are common comorbid conditions in the elderly, and often coexist. Biochemical abnormalities in the homeostasis of calcium and phosphorus begin early in CKD, leading to an increase in fracture risk and cardiovascular complications since early stages of the disease. The ability of DXA (dual energy X-ray absorptiometry) to diagnose osteoporosis and to predict fractures in this population remains unclear. The management of the disease is also controversial: calcium and vitamin D, although recommended, must be prescribed with caution, considering vascular calcification risk and the development of adynamic bone disease. Furthermore, safety and effectiveness of osteoporosis drugs are not established in patients with CKD. Thus, risks and benefits of antiosteoporosis treatment must be considered individually. RESUMOO envelhecimento associa-se tanto ao declínio da qualidade óssea quanto da filtração glomerular. Consequentemente, osteoporose e doença renal crônica (DRC) são comorbidades frequentes em idosos, e muitas vezes coexistem. Anormalidades bioquímicas na homeostase do cálcio e do fósforo surgem precocemente na DRC, causando aumento do risco de fraturas e de complicações cardiovasculares desde fases precoces da doença. A capacidade da densitometria (DXA) em diagnosticar osteoporose e predizer fraturas nessa população é questionável. O manejo da doença é também controverso; cálcio e vitamina D são recomendados com cautela, devido ao risco de calcificações vasculares e de doença óssea adinâmica. Além disso, a segurança e a eficácia dos medicamentos para osteoporose ainda não estão estabelecidas em pacientes com DRC. Assim, riscos e benefícios do tratamento para osteoporose devem ser considerados individualmente nesses pacientes. Arq Bras Endocrinol Metab. 2014;58(5):530-9 Descritores Qualidade

Study of Atypical Femoral Fracture Cases Coupled in a Multicenter Study

“…5C). There have also been reports showing that some drugs (e.g., steroids, TZD, and PPIs) and comorbidities (e.g., SLE, RA, DM or CKD) are associated with the occurrence of insufficiency fractures [10][11][12]. These factors are also considered to be involved in the development of AFF.…”

Effectiveness of antiresorptive medications in women on long-term dialysis after hip fracture: A population-based cohort study

“…Not only do patients have lower willingness to receive an invasive examination but bone biopsy requires experts to interpret the results as well. Furthermore, bone biopsy can only reflect the bone mass at a single time, and it cannot represent the whole body of the bone, and additionally, the measurement does not take into account the CKD stage and the time of disease [28,29]. As a consequence, clear consensus on using AR drugs in the dialysis population for second hip fracture prevention is still lacking, but in spite of this lack of obvious benefit on fracture prevention, our results shed light on exploring potential mechanisms (conditions) explaining the association between AR and refracture in the dialysis population.…”

Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD)

“…As increased PTH levels constitutes a contraindication to teriparatide, the use of this drug in CKD, a condition related to HPT, seems inappropriate. Teriparatide might be useful in CKD patients with adynamic bone disease and in those who underwent prior parathyroidectomy [70].…”

“…However, due to the renal excretion of strontium, it is contraindicated in patients with a GFR ˂30 ml/min i.e. CKD stages IV and V. The European Medicines Agency (EMA) recommends using of strontium based on reports of patients with CVD complications using this drug [70].…”