Bisphophonates in CKD Patients with Low Bone Mineral DensityReport as inadecuate




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The Scientific World JournalVolume 2013 2013, Article ID 837573, 11 pages

Review Article

Department of Internal Medicine, Department of Health, Ministry of Health and Welfare, Chia-Yi Hospital, Chia-Yi, Taiwan

Department of Internal Medicine, Cardinal Tien Hospital, Yong He Branch, New Taipei, Taiwan

Division of Nephrology, Department of Medicine, Cathay General Hospital, Taipei, Taiwan

Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien, New Taipei 231, Taiwan

Received 12 November 2013; Accepted 27 November 2013

Academic Editors: D. Geetha and F. Thaiss

Copyright © 2013 Wen-Chih Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Patients with chronic kidney disease-mineral and bone disorder CKD-MBD have a high risk of bone fracture because of low bone mineral density and poor bone quality. Osteoporosis also features low bone mass, disarranged microarchitecture, and skeletal fragility, and differentiating between osteoporosis and CKD-MBD in low bone mineral density is a challenge and usually achieved by bone biopsy. Bisphosphonates can be safe and beneficial for patients with a glomerular filtration rate of 30 mL-min or higher, but prescribing bisphosphonates in advanced CKD requires caution because of the increased possibility of low bone turnover disorders such as osteomalacia, mixed uremic osteodystrophy, and adynamic bone, even aggravating hyperparathyroidism. Therefore, bone biopsy in advanced CKD is an important consideration before prescribing bisphosphonates. Treatment also may induce hypocalcemia in CKD patients with secondary hyperparathyroidism, but vitamin D supplementation may ameliorate this effect. Bisphosphonate treatment can improve both bone mineral density and vascular calcification, but the latter becomes more unlikely in patients with stage 3-4 CKD with vascular calcification but no decreased bone mineral density. Using bisphosphonates requires considerable caution in advanced CKD, and the lack of adequate clinical investigation necessitates more studies regarding its effects on these patients.





Author: Wen-Chih Liu, Jen-Fen Yen, Cheng-Lin Lang, Ming-Tso Yan, and Kuo-Cheng Lu

Source: https://www.hindawi.com/



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