Bisphosphonate therapy in renal osteodystrophy--a review

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Background:

• Bisphosphonates are standard treatments for osteoporosis and bone diseases.
• Severe renal insufficiency typically contraindicates bisphosphonate use due to kidney elimination.
• Dialysis patients often have impaired bone metabolism, suggesting a potential role for bisphosphonates.

Purpose of the Study:

• To evaluate the potential use of bisphosphonates in patients with renal osteopathy undergoing dialysis.
• To assess the efficacy of bisphosphonates in managing hyperparathyroid bone changes in animal models and dialysis patients.

Main Methods:

• Review of animal studies demonstrating bisphosphonate effects on hyperparathyroid bone changes.
• Analysis of bisphosphonate dialyzability (clodronate, pamidronate, ibandronate).
• Examination of initial pilot studies in dialysis patients.

Main Results:

• Animal studies indicate bisphosphonates can inhibit hyperparathyroid bone changes.
• Clodronate, pamidronate, and ibandronate are shown to be readily dialyzable.
• Pilot studies suggest positive effects on hyperparathyroid bone disease in dialysis patients.

Conclusions:

• Bisphosphonates may be judiciously used in dialysis patients with impaired bone metabolism.
• The dialyzability of certain bisphosphonates facilitates their use in this population.
• Large, randomized, placebo-controlled trials are necessary to establish general recommendations for bisphosphonates in renal osteopathy.