Baltimore, MD—New research is raising questions about the safety of osteoporosis medications in patients with chronic kidney disease (CKD).

The report in Annals of Internal Medicine suggests the issue is of significant concern because CKD raises the risks of fractures and weakened bones. Yet, according to Johns Hopkins University Bloomberg School of Public Health–led researchers, not enough is known about benefits and harms of those medications on bone mineral density (BMD), fracture risk, and safety among CKD patients.

To try to determine that, the study team reviewed published research to ascertain the benefits and harms of bisphosphonates, teriparatide, raloxifene, and denosumab compared with placebo—defined as usual care—based on the three measures.

The meta-analysis used PubMed and the Cochrane Central Register of Controlled Trials from December 2006 through December 2016. Reviewed were 13 trials involving 9,850 patients, including kidney transplant recipients in six trials; patients who had stage 3 to 5 CKD, or who were receiving dialysis in three trials; or postmenopausal women with CKD in four trials.

Results indicate that bisphosphonates might slow loss of BMD among transplant recipients, but their effects on fractures and safety in transplant recipients and others with CKD were less clear. At the same time, raloxifene appears to prevent vertebral fractures but might not improve BMD. Effects of teriparatide and denosumab on BMD and fractures remained unclear, however, and researchers express concerns that those medications could increase risk for some safety outcomes.

In doing the research, study authors say they faced “unclear rigor of evidence, possible reporting biases, and scant evidence among patients with stage 3 to 5 CKD,” adding, “Effects of osteoporosis medications on BMD, fracture risk, and safety among patients with CKD are not clearly established.”

They call for more research to determine the best options for patients across the spectrum of CKD in an effort to improve BMD and prevent fractures while also minimizing risk.

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