Bisphosphonate prescribing in chronic kidney disease

Abstract

Osteoporosis and chronic kidney disease (CKD) are both increasingly prevalent with advancing age. Bisphosphonates are licensed for use in osteoporosis, but the appropriateness and safety of this class of drug in CKD is uncertain. This study assessed the use of bisphosphonates for persons with CKD in clinical practice. The prescribing pattern of bisphosphonates in all 595 persons attending renal services in one UK hospital was analysed. The mean estimated glomerular filtration rate (eGFR) of the population was 44 + 23 ml/min/1.73m2. Bisphosphonate treatment was prescribed for 32 patients (5%), of whom 13 had an eGFR <30 ml/min/1.73m2 and two patients received maintenance dialysis therapy. Thirty-nine (7%) patients were prescribed corticosteroid therapy; 9/23 with an eGFR >30 ml/min/1.73m2 were not prescribed bisphosphonate medication. Twenty-two (4%) patients had osteoporosis; 5/9 with an eGFR >30 ml/min/1.73m2 were not prescribed bisphosphonate medication. Bisphosphonate medication was not prescribed to a proportion of persons with early CKD (stages 1–3) who could potentially benefit from such therapy; conversely such treatments were used in some patients with severe CKD (stages 4 and 5). This pattern of bisphosphonate prescribing arguably reflects the uncertainty about the efficacy and safety of such treatment for persons with CKD.