The risk of cumulative renal effects of intravenous bisphosphonates

Some level of renal dysfunction is common in patients with cancer. This could be a result of an age-related kidney function decrease, the underlying disease (eg, multiple myeloma), or the effects of nephrotoxic medications. Some intravenous (I.V.) bisphosphonates have been associated with occasional renal toxicity in the clinical setting. Therefore, the choice of an I.V. bisphosphonate should take into account the risk of renal deterioration. Preclinical studies also suggest that there might be considerable differences between the renal safety profiles of commonly used I.V. bisphosphonates. Variations in the risk of histopathologic damage and the ability to cause cumulative toxicity have been observed in comparative preclinical studies of I.V. bisphosphonates. The reasons for these apparent differences are not fully understood. Research shows that renal safety profiles might be influenced by pharmacokinetic properties, such as renal tissue half-life, protein binding, and intracellular potency. Preclinical analyses are warranted in order to confirm and evaluate these differences between bisphosphonates.