Bisphosphonate utilization across the spectrum of eGFR

Bisphosphonates are the most common treatment for osteoporosis but there are concerns regarding its use in CKD. We evaluated the frequency of BSP by eGFR categories among patients with osteoporosis from two healthcare systems. Our results show that 56% of patients were treated, with reduced odds in those with lower eGFR.

Osteoporosis is common in patients with chronic kidney disease (CKD). Bisphosphonates (BSP) are the most common treatment but there are concerns regarding its efficacy and toxicity in CKD. We evaluated the frequency of BSP use by level of estimated glomerular filtration rate (eGFR) in patients with osteoporosis.

We assessed BSP use in patients with incident osteoporosis from the SCREAM-Cohort, Stockholm-Sweden, and Geisinger Healthcare, PA, USA. Osteoporosis was defined as the first encountered ICD diagnosis, and BSP use was defined as the dispensation or prescription of any BSP from 6 months prior to 3 years after the diagnosis. Multinomial logistic regression was used to account for the competing risk of death.

A total of 15,719 women and 3011 men in SCREAM and 17,325 women and 3568 men in Geisinger with incident osteoporosis were included. Overall, 56% of individuals used BSP in both studies, with a higher proportion in women. After adjustments, the odds of BSP was lower across lower eGFR in SCREAM, ranging from 0.90 (0.81-0.99) for eGFR 75-89 mL/min/1.73m² to 0.56 (0.46-0.68) for eGFR 30-44 mL/min/1.73m² in women and from 0.72 (0.54-0.97) for eGFR of 60-74 to 0.42 (0.25-0.70) for eGFR 30-44 mL/min/1.73m² in men. In Geisinger, odds were lower for eGFR < 30 mL/min/1.73m² in both sexes and the frequency of BSP use dropped over time.

In the two healthcare systems, approximately half of the people diagnosed with osteoporosis received BSP. Practices of prescription in relation to eGFR varied, but those with lower eGFR were less likely to receive BSP.