Treatment of osteoporosis in renal insufficiency

L.G. Schipper, H.W. Fleuren, J.P. van den Bergh, J.R. Meinardi, B.A. Veldman, C. Kramers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Patients with osteoporosis often have chronic kidney disease (CKD). CKD is associated with bone and mineral disturbances, renal osteodystrophy, which like osteoporosis leads to a higher risk of fractures. Bisphosphonates are first-line therapy for osteoporosis; however, these are contra-indicated in patients with a GFR <30 ml/min. In this article, we have reviewed the diagnosis and treatment of osteoporosis in moderate to severe renal failure from data of clinical trials. Results have shown that osteoporosis patients and severe CKD with no signs of renal osteodystrophy, oral bisphosphonates (risedronate) seem to be a safe choice. Renal function and PTH should subsequently be monitored strictly. Denosumab, with regularly monitoring of calcium and adequate vitamin D levels or raloxifene are a possible second choice. In any case, one should be certain that there is no adynamic bone before treatment can be started. If there is any doubt, bone biopsies should be taken.
Original languageEnglish
Pages (from-to)1341-1345
Number of pages5
JournalClinical Rheumatology
Volume34
Issue number8
DOIs
Publication statusPublished - Aug 2015

Keywords

  • Bisphosphonates
  • Denosumab
  • Osteoporosis
  • Renal insufficiency
  • CHRONIC KIDNEY-DISEASE
  • POSTMENOPAUSAL WOMEN
  • POOLED ANALYSIS
  • BONE-DISEASE
  • FRACTURE
  • IBANDRONATE
  • BISPHOSPHONATE
  • HYPOCALCEMIA
  • SAFETY
  • HYPERPARATHYROIDISM

Cite this

Schipper, L. G., Fleuren, H. W., van den Bergh, J. P., Meinardi, J. R., Veldman, B. A., & Kramers, C. (2015). Treatment of osteoporosis in renal insufficiency. Clinical Rheumatology, 34(8), 1341-1345. https://doi.org/10.1007/s10067-015-2883-4