Using Osteoporosis Medications in People with Chronic Kidney Disease

"Poster" by the CDC outlining Chronic Kidney Disease

Still more information needed on the use of osteoporosis medications in people with chronic kidney disease.

Chronic kidney disease (CKD) carries a risk of weak bones and fractures. The question is whether the potential risks of medication for osteoporosis offset potential benefits.

A new study from Johns Hopkins University compared the most commonly-used osteoporosis medications in patients with CKD. The study showed no clear winner and found some potential risks.

CKD occurs when the kidneys gradually lose the ability to function. Diabetes and high blood pressure are the most common causes. Eventually, the kidneys fail entirely and dialysis is necessary to sustain the patient’s life. One of the complications of CKD is weak bones that are more susceptible to fractures.

Lead author Lisa M. Wilson, ScM, and colleagues analyzed data from multiple studies (a meta-analysis), comparing the effectiveness, complications and potential risks of several osteoporosis medications: bisphosphonates, teriparatide, raloxifene, and denosumab.

Wilson is a research associate at Johns Hopkins University Bloomberg School of Medicine.

The researchers compared the osteoporosis medications against placebos (fake pills), usual care, exercise and activities to promote bone mineral density.

The data indicated that bisphosponates (brand names Actonel, Boniva, Fosamax) can slow bone loss in people who have had kidney transplants. However, information on safety and fractures was not clear.

The researchers found raloxifene (brand name Evista) may help to prevent spine fractures, but there was no indication that it improved bone density. Teriparatide (brand name Forteo) and denosumab (brand names Prolio and XGEVA) may actually increase risk in CKD patients and the data did not show clear effects on bone density.

The authors recommended further research.

The study was published in the April issue of Annals of Internal Medicine.

Funding for the study was provided by Kidney Disease: Improving Global Outcomes.

Co-author Casey M. Rebholz, PhD, reported a grant from the National Institute of Diabetes and Digestive and Kidney Diseases outside of the submitted work. There were no other conflicts of interest.

American College of Physicians, “Benefits and harms of osteoporosis medications unclear for patients with CKD”
Written by: Beth Greenwood, RN | Medically reviewed by: Dr. Robert Carlson, M.D.