Bisphophonates in CKD Patients with Low Bone Mineral Density
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 osteoporo...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1155/2013/837573 |
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| author | Wen-Chih Liu Jen-Fen Yen Cheng-Lin Lang Ming-Tso Yan Kuo-Cheng Lu |
| author_facet | Wen-Chih Liu Jen-Fen Yen Cheng-Lin Lang Ming-Tso Yan Kuo-Cheng Lu |
| author_sort | Wen-Chih Liu |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-44e96caf615a488b9b6d41e6eeb47592 |
| institution | Kabale University |
| issn | 1537-744X |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-44e96caf615a488b9b6d41e6eeb475922025-02-03T01:12:23ZengWileyThe Scientific World Journal1537-744X2013-01-01201310.1155/2013/837573837573Bisphophonates in CKD Patients with Low Bone Mineral DensityWen-Chih Liu0Jen-Fen Yen1Cheng-Lin Lang2Ming-Tso Yan3Kuo-Cheng Lu4Department of Internal Medicine, Department of Health, Ministry of Health and Welfare, Chia-Yi Hospital, Chia-Yi, TaiwanDepartment of Internal Medicine, Department of Health, Ministry of Health and Welfare, Chia-Yi Hospital, Chia-Yi, TaiwanDepartment of Internal Medicine, Cardinal Tien Hospital, Yong He Branch, New Taipei, TaiwanDivision of Nephrology, Department of Medicine, Cathay General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien, New Taipei 231, TaiwanPatients 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.http://dx.doi.org/10.1155/2013/837573 |
| spellingShingle | Wen-Chih Liu Jen-Fen Yen Cheng-Lin Lang Ming-Tso Yan Kuo-Cheng Lu Bisphophonates in CKD Patients with Low Bone Mineral Density The Scientific World Journal |
| title | Bisphophonates in CKD Patients with Low Bone Mineral Density |
| title_full | Bisphophonates in CKD Patients with Low Bone Mineral Density |
| title_fullStr | Bisphophonates in CKD Patients with Low Bone Mineral Density |
| title_full_unstemmed | Bisphophonates in CKD Patients with Low Bone Mineral Density |
| title_short | Bisphophonates in CKD Patients with Low Bone Mineral Density |
| title_sort | bisphophonates in ckd patients with low bone mineral density |
| url | http://dx.doi.org/10.1155/2013/837573 |
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