Osteoporosis Drugs for CKD Patients—Jury’s Still Out

Currently available data cannot establish the safety and efficacy of osteoporosis medications for patients with chronic kidney disease (CKD), concludes a meta-analysis in Annals of Internal Medicine.

A systematic review identified 13 randomized trials, including a total of 9850 patients, evaluating the clinical benefits and safety outcomes of osteoporosis medications in CKD patients. The medications studied were bisphosphonates, teriparatide, raloxifene, and denosumab. Outcomes of interest were bone mineral density (BMD), fractures, mortality, and adverse events. Kidney transplant recipients were enrolled in six trials, postmenopausal women with CKD in four, and patients with CKD stage 3 to 5 or on dialysis in three.

There was moderately strong evidence that bisphosphonates slow BMD loss of the lumbar spine in kidney transplant patients. However, the effects in the femoral neck and other areas were unclear. There were conflicting or insufficient data on the effects of bisphosphonates on BMD in CKD patients who had not received a transplant. Bisphosphonates’ effects on fracture risk and safety outcomes were unclear.

There was low strength of evidence that raloxifene prevents vertebral fractures, but not that it increased BMD. Evidence on the effectiveness of teriparatide and denosumab was weak, with some data suggesting an increased risk of adverse outcomes.

Bone weakening and fractures are potential complications of CKD, leading to recommendations for treatment with medications for osteoporosis. But the new review shows an overall weak body of evidence for the safety and effectiveness of osteoporosis medications across the spectrum of CKD. The authors discuss the need for further studies, especially in patients with CKD stage 3 to 5 [Wilson LM, et al. Benefits and harms of osteoporosis medications in patients with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med 2017; DOI: 10.7326/M16-2752].

May 2017 (Vol. 9, Number 5)