1. While osteoporosis medications may have some benefits in chronic kidney disease patients (CKD), the evidence is unclear with respect to their impact on bone mineral density (BMD) and fracture risk.
2. The safety of osteoporosis medications among CKD patients is not clearly established.
Evidence Rating Level: 1 (Excellent)
Study Rundown: CKD results in many complications, including osteoporosis, weakened BMD, and increased fracture risk. Over the past 5 years, new treatments have emerged for osteoporosis that may be relevant for CKD-MBD patients; however, their efficacy is unclear. Therefore, the authors of this study aimed to conduct a systematic review regarding efficacy and safety of osteoporosis medications for CKD-MBD, including bisphosphonates, teriparatide, raloxifene, and denosumab. In general, they observed that the benefits and harms of osteoporosis medications remain unclear for patients with CKD. This study has several limitations. First, the results of this study may have limited application to the general population of patients with CKD. For example, many of these drugs were not studied in men or pre-menopausal women. Additionally, this study is also limited with respect to the potential for reporting bias. Overall, these results suggest that the efficacy of osteoporosis medications on BMD, fracture risk and safety in CKD-MBD patients remains uncertain.
Relevant Reading: Diagnosis and treatment of osteoporosis in chronic renal disease.
In-Depth [systematic review]: The authors conducted a systematic literature review utilizing PubMed and the Cochrane Central Register of Controlled Trials from December 2006-2016. In total, 13 trials were included in the qualitative synthesis, and 10 studies were included in the meta-analysis. Studies were selected using paired reviewers that assessed articles independently. Articles were included if written in the English language and were randomized, controlled trials that compared bisphosphonates, teriparatide, denosumab, or raloxifene with placebo in a sub group of CKD patients. Generally, the results of the study suggested that the evidence for the use of osteoporosis medications in CKD patients is not clearly established. For example, it was observed that while raloxifene may prevent vertebral fractures, it might not improve BMD. Additionally, teriparatide and denosumab may increase risk for certain safety outcomes in CKD patients.
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