Bisphosphonates, a drug class used to prevent the loss of bone density, are the first-line treatment for preventing fracture in osteoporosis patients. Osteoporosis is often associated with patients with chronic kidney disease (CKD), who can suffer from low bone density and increased fracture risk, but there was little information available on the safety of bisphosphonates in patients with CKD.
Moderate to severe (stages 3-5) chronic kidney disease (CKD) affects up to 2.8 million people in the UK and 2.7 million people in Spain.
The Prieto-Alhambra Group for pharmaco- and device epidemiology at NDORMS, in collaboration with SIDIAP, set out to understand the safety profile of bisphosphonates in patients with moderate to severe CKD. Using primary-care electronic records from two patient cohorts in the UK and Catalonia, Spain, they analysed the data from 4,000 bisphosphonate users and more than 15,000 non-users.
Victoria Strauss, lead statistician at NDORMS said: “Our primary outcome was CKD stage worsening, the risk that patients may move to a more severe form of the disease and which could potentially lead to dialysis or transplant. We saw a modest (15%) risk of CKD progression with bisphosphonate use. This adds to the body of work in this area and should act as a guide to clinicians to carefully consider the risk-benefit of prescribing bisphosphonate to moderate to severe CKD patients for the management of osteoporosis.”
The study found no risk differences for acute kidney injury, gastrointestinal bleeding/ulcers, or hypocalcaemia.
The study, published in JMBR (Journal of Molecular Biology Research), was funded by the Health Technology Assessment Programme, and the Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, and supported by the NIHR Bio-medical Research Centre.