Highly Controversial Treatment Of Bone Disorders In CKD Patients Could Greatly Impact Treatment


Fractures are extremely common in patients with CKD and cause impaired quality of life as well as increased risk of death. Contention over the idea that osteoporosis drugs can and should be used to prevent fractures in patients with Chronic Kidney Disease (CKD) despite various continuing unknowns was debated at the American Society of Bone and Mineral Research (ASBMR) last week. Sophie A. Jamal, MD, PhD (associate professor of medicine at the University of Toronto) said that "There are plenty of data showing these drugs to be safe and effective for CKD patients with osteoporosis." However, others such as Alastair R. McLellan, MD are convinced that there is no one drug that "can reduce the incidence of hip, nonhip, or nonvertebral fractures, or even clinical vertebral fractures" in CKD patients.

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While osteoporosis drugs such as alendronate, ibandronate and risedronate are not recommended for people with CKD by the US Food and Drug Administration (FDA) because of impaired creatinine clearance and zoledronic acid, Dr. Jamal argued that recommendations are currently based on limited information. It was suggested that several studies show reductions of fractures and bone density (health and strength of your bones) improvements in CKD patients. Also, some osteoporosis treatments have no FDA warning for use by individuals with CKD. 

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Still, the popular opinion is that people with CKD have important distinctions that set them apart from patients who have only osteoporosis. The potential adverse effects associated with osteoporosis drugs in CKD  include serious bone fractures (atypical femoral fractures), spinal curving and depression from elevated calcium (hypercalcemia) and further kidney injury in earlier stage CKD patients. Specifically in individuals with End Stage Renal Disease (ESRD) there is an acknowledged lack of studies that support the use of general osteoporosis treatment. 

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Overall bone disorders in people with CKD have been showing upward trends in recent reports. Yet, the concern of safety coupled with efficiency cause many Nephrologists to avoid recommending osteoporosis drugs to their patients. However, if you are suffering from bone disease and are concerned about your risk of fracturing, KidneyBuzz.com recommends that you discuss corrective options with your Nephrologist. If you are diagnosed with osteoporosis specifically, then you should investigate with your healthcare team all of the options available to you so that you can make the best and most informed decision for your personal health. Note that a good treatment program, including proper attention to diet, appropriate dialysis, exercise and properly taking prescribed medications, can improve your body’s ability to repair bones damaged by common Mineral and Bone Disorders. 

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Melville, Nancy A. "Debate Continues on Osteoporosis Treatment in CKD." MedScape. 

"Hypercalcemia." Medicine.net.