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Patients with chronic kidney impairment suffer from bone fragility. Yet, most fracture protective therapies are contraindicated for them due to uncertainty on specific safety issues. We will use anonymised electronic medical records data from patients who have used first line anti-osteoporosis treatments (i.e. The so called bisphosphonates) to explore their potential benefits (fracture risk reduction) and risks.

Risks and Benefits of bisphosphanate use in patients with chronic kidney disease

BACKGROUND

Patients with renal impairment have an increased risk of fractures. However, the most commonly used drugs to prevent these could have serious side effects for them. We will use data from thousands of patients with CKD who have been previously exposed to bisphosphonates to determine whether these medications are both safe and effective for them. - Daniel Prieto-Alhambra, Principal Investigator

With the aging population a growing number of patients are living with kidney disease. Kidney disease is associated with a significantly increased risk of broken bones (fractures) with substantial implications for patients, NHS and society. Although there are effective drugs such as bisphosphonates that reduce the risk of fracture in patients with osteoporosis (brittle bones), these drugs are untested in patients with kidney disease where the biology of the bone disease leading to bone fragility can be different. In addition some data suggests that these first-line bone therapies may worsen kidney function. Indeed, patients with kidney disease were under-represented or excluded from most randomised clinical trials, leaving a gap in the current medical knowledge about the potential benefits and risks of these medications in this growing group of the population. This evidence gap has led some to use untested treatment regimens in an attempt to reduce the risk of fracture.

OBJECTIVES

To address this, we propose to use ‘real life’ data as routinely collected in NHS clinical practice including primary and hospital care anonymised records for millions of UK people (the called CPRD/HES database), linked to the UK Renal Registry data, with detailed information on end-stagekidney disease. Finally, a unique Danish dataset including all patients who had a bone density scan in 1995-2013 will be used to study the effect of bisphosphonates on bone density in patients with kidney disease.

Our team

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This project is funded by the National Institute for Health Research's HTA Programme.

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