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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


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.


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-stage kidney 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.

Data sources

For more information about how the UK Renal Registry and NHS Digital use patient information, including how it is collected and how patients can opt out from them, follow the links below:

UK Renal Registry - Patient Information

UK Renal Registry - Contact

NHS Digital - Data collection

NHS Digital - opt out

This study is to be based in part on data from the Clinical Practice Research Datalink (CPRD) obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is to be provided by patients and collected by the NHS as part of their care and support. For more information about how CPRD uses patient data, including how it is collected and how patients can opt out of anonymised information from health records being used in medical research, visit



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

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