There are no clearly established effects of osteoporosis medications on bone mineral density, fracture risk and safety in patients with chronic kidney disease, according to findings published in Annals of Internal Medicine.
To determine the safety and efficacy of osteoporosis medications in patients with chronic kidney disease (CKD) in comparison to placebo, usual care or active control of bone mineral density (BMD) and fractures, Lisa M. Wilson, SCM, from Johns Hopkins University Bloomberg School of Public Health, and colleagues performed a systematic review and meta-analysis.
They searched PubMed and the Cochrane Central Register of Controlled Trials for randomized studies that assessed such outcomes and were published between December 2006 and December 2016. Reviewers independently evaluated the risk of bias and graded the strength of evidence of the extracted data. Osteoporosis medications evaluated included bisphosphonates, teriparatide, raloxifene and denosumab.
The researchers identified 13 trials (n = 9,850): six studied kidney transplant recipients, four studied postmenopausal women with CKD, and three studied patients who had stage 3 to 5 CKD or were receiving dialysis. Moderate-strength evidence indicated that among transplant recipients, bisphosphonates potentially slow BMD loss. However, in this subpopulation and other patients with CKD, bisphosphonates have uncertain effects on fractures and safety. Low-strength evidence showed that vertebral fractures may be prevented, but BMD may not be improved by raloxifene use. Very low-strength evidence revealed uncertain effects of teriparatide and denosumab on BMD and fractures. In addition, teriparatide and denosumab were associated with a greater risk of adverse events.
“More research is needed to determine the best options for patients across the spectrum of CKD to improve BMD and prevent fractures with minimal risk for adverse outcomes,” Wilson and colleagues concluded. “In particular, we need more data among patients with stage 3 to 5 CKD. Studies should be adequately powered to show a reduction in the risk for fractures and should have sufficient follow-up ( 3 years). Future research should also provide details about trial methods, should specify a priori how outcomes will be measured and reported, and should report on adverse events and safety.” – by Alaina Tedesco
Disclosure: The researchers report primary funding from Kidney Disease: Improving Global Outcomes.