Bisphosphonates, a class of drugs used as treatment for osteoporosis, decrease bone fractures and mortality. Their risks and benefits, however, had not been carefully studied in chronic kidney disease (CKD) patients. In a study published in the Journal of Bone and Mineral Research, researchers investigated the use of oral bisphosphonate treatment in CKD patients ranging from moderate (3B) to severe (5D).*

Background information

CKD patients often have osteoporotic fractures and fracture-related mortality, due to alterations in their mineral metabolism. Similarly, more than 1 in 4 people with osteoporosis also have CKD. Changes in bone structure usually happen early in the disease’s course and worsen as kidney function deteriorates. Those who are in an early stage of CKD tend to have more traditional forms of osteoporosis, while patients with advanced CKD may experience various and more complex mineral and bone disorders. 

A growing body of evidence shows that the risk of fracture depends on the patient’s stage of CKD. Multiple studies demonstrated that osteoporosis treatment reduces the mortality risk after osteoporotic fractures. Data on the effectiveness and safety of bisphosphonates for CKD patients, however, was scarce, especially for those with severely reduced kidney function.

Research and investigation details

An international team from Sydney (Australia); Oxford, Bristol, and Southampton (U.K.); Barcelona (Spain); and Odense and Holbaek (Denmark) investigated the effect of oral bisphosphonates on bone fractures and mortality in patients with moderate-to-severe CKD. The authors examined data on 230,305 participants at varying stages of CKD. Among them, 19,351 patients received oral bisphosphonate, while the other 210,954 did not. The period of follow-up ranged from 1996 to 2016. The study’s strength comes from the inclusion of two large groups of people from two different countries (the U.K. and Spain).

Results and conclusions

The study concluded that oral bisphosphonate treatment is not linked to increased mortality in patients with moderate to severe CKD. Moreover, the results showed that bisphosphonates may even be connected to decreased mortality in certain cases—particularly in women, patients with prior fracture history, and patients with stage G4 to 5D CKD. 

Additional studies, however, will be necessary to determine what other potential effects oral bisphosphonate may have on CKD patients.

Further reading can be found on Endocrinology Advisor in the article, “Oral Bisphosphonates Do Not Increase Mortality Risk in Patients With Chronic Kidney Disease.”

*Alarkawi, D., Sanni Ali, M., Bliuc, D., Pallares, N., et al. (2020, Feb.18). Oral Bisphosphonate Use and All‐Cause Mortality in Patients With Moderate–Severe (Grade 3B‐5D) Chronic Kidney Disease: A Population‐Based Cohort Study. Journal of Bone and Mineral Research.