Bisphosphonates in chronic kidney disease; balancing potential benefits and adverse effects on bone and soft tissue

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Cardiovascular disease (CVD) is common in chronic kidney disease (CKD), linked to vascular stiffness and calcification.
• An inverse relationship exists between arterial calcification and bone mineral density (BMD), complicating osteoporosis management in advanced CKD.
• Limited data exists on bisphosphonate use for CKD-mineral and bone disorder (MBD) due to exclusion from prior studies.

Purpose of the Study:

• To review the benefits and risks of bisphosphonates for bone protection in CKD patients.
• To assess the impact of bisphosphonates on vascular calcification and atherosclerosis in CKD.
• To provide guidance on selective and cautious bisphosphonate use in CKD-MBD.

Main Methods:

• Literature review of experimental and clinical studies on bisphosphonates in CKD.
• Analysis of bisphosphonate effects on bone mineral density (BMD) and bone turnover.
• Evaluation of bisphosphonate impact on vascular calcification and atherosclerosis progression.

Main Results:

• Bisphosphonates may offer bone protection but carry risks like worsening low bone turnover and hyperparathyroidism in CKD.
• Some evidence suggests bisphosphonates may reduce extra-osseous calcification and inhibit atherosclerosis.
• Standard osteoporosis therapies may be harmful in CKD-MBD, necessitating careful bisphosphonate consideration.

Conclusions:

• Bisphosphonate use in CKD requires careful risk-benefit assessment, especially in advanced stages with MBD.
• Selective bisphosphonate administration may be beneficial for bone health and potentially vascular complications in CKD.
• Further research is needed to clarify optimal bisphosphonate strategies in CKD patients with MBD.