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Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant
Naohiko Fujii1, Takayuki Hamano, Satoshi Mikami
1FASN Department of Internal Medicine, Osaka University School of Medicine, Box A8, 2-2 Yamada-oka, Suita 565-0871, Japan.
Insights
Risedronate effectively increases bone mineral density in chronic kidney disease patients on glucocorticoids, with or without active vitamin D. Bone markers can help predict treatment response.
Area of Science:
- Nephrology
- Endocrinology
- Rheumatology
Background:
- Glucocorticoids are frequently used in patients with chronic kidney disease (CKD).
- Long-term glucocorticoid use can lead to bone loss and increased fracture risk.
- The efficacy of risedronate combined with active vitamin D in CKD patients on glucocorticoids was previously unknown.
Purpose of the Study:
- To investigate the efficacy of risedronate, with or without active vitamin D, in preserving bone mineral density (BMD) in CKD patients receiving long-term glucocorticoid therapy.
Main Methods:
- A prospective study included 114 CKD patients on glucocorticoids.
- Patients received either active vitamin D alone (Group A), active vitamin D plus risedronate (Group B), or risedronate alone (Group C).
- Bone mineral density and bone turnover markers were assessed over one year.
Main Results:
- Risedronate significantly increased lumbar BMD in patients receiving it (Groups B and C), while BMD decreased in the active vitamin D only group (Group A).
- Bone turnover markers (S-NTX and bone ALP) decreased significantly in groups receiving risedronate.
- No significant differences in BMD or bone markers were observed between risedronate with active vitamin D versus risedronate alone.
Conclusions:
- Risedronate is effective in increasing BMD in CKD patients on long-term glucocorticoid therapy, irrespective of concurrent active vitamin D use.
- Bone turnover markers show potential in predicting patient response to anti-resorptive therapy.
Background:
Recent post hoc analysis proved the efficacy and tolerability of risedronate in osteoporotic patients with renal impairment, but the combination of active vitamin D in chronic kidney disease (CKD) patients taking glucocorticoids remains unknown.
Methods:
We conducted a prospective study enrolling 114 CKD patients (creatinine clearance > or =30 ml/min/1.73 m(2)) receiving glucocorticoid therapy for > or =6 months. Eighty-eight subjects who had received active vitamin D (aVD) were randomly assigned to either a group treated with aVD only (group A), or to a group also receiving risedronate 2.5 mg/day (group B). The remaining patients (group C) received risedronate only.
Results:
After 1 year 100 subjects were analysed. Risedronate was effective on the lumbar spine, but not on the femoral neck. The lumbar bone mineral density (BMD) significantly increased by 2.8 and 2.5% in groups B and C, respectively, but decreased by 1.0% in group A. Serum N-terminal telopeptides of type I collagen (S-NTX) and bone alkaline phosphatase (ALP) fell significantly in groups B and C at 3 and 6 months, respectively, while in group A S-NTX remained unchanged and bone ALP significantly increased. There was no significant difference between groups B and C regarding BMD and bone markers. The reduction rate of S-NTX (bone ALP) at 6 months predicted the increase in lumbar BMD at 1 year with a sensitivity of 73% (34%) and a specificity of 46.2% (100%).
Conclusions:
Risedronate is effective in increasing BMD with or without aVD in CKD patients receiving long-term glucocorticoid therapy. Bone markers are of some use in predicting the response to anti-resorptive therapy.
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