Relationship between age, renal function and bone mineral density in the US population.

Area of Science:

• Nephrology
• Endocrinology
• Geriatrics

Background:

• Bisphosphonate drugs are a primary treatment for osteoporosis.
• These medications are renally excreted, necessitating careful consideration in patients with impaired kidney function.
• Major clinical trials for bisphosphonates have frequently excluded individuals with significant renal compromise.

Purpose of the Study:

• To investigate the prevalence of renal dysfunction among men and women diagnosed with osteopenia and osteoporosis.
• To inform physicians about the potential for renal compromise in osteoporosis patients considered for bisphosphonate therapy.

Main Methods:

• Utilized data from 13,831 adults from the Third National Health and Nutrition Examination Survey (NHANES III).
• Estimated creatinine clearance (CCr) using the Cockcroft-Gault (C-G) formula based on serum creatinine, weight, and age.
• Defined osteopenia and osteoporosis using World Health Organization (WHO) bone mineral density (BMD) criteria.

Main Results:

• In women aged 20-80+ with osteoporosis, 85% exhibited mild to moderate renal compromise (CCr ≤60 ml/min), and 24% had severe compromise (CCr <35 ml/min).
• Severe renal compromise prevalence in women with osteoporosis increased significantly with age, reaching 54% in those 80+.
• Approximately 11% of men with osteoporosis had severe renal compromise, compared to 24% of women.

Conclusions:

• A substantial proportion of patients with osteoporosis and osteopenia seeking treatment have significant renal compromise.
• There is a notable lack of clinical trial data regarding the efficacy and safety of bisphosphonates in osteoporosis patients with renal impairment.
• Physicians should be aware of the high prevalence of renal dysfunction in this patient group when considering bisphosphonate treatment.