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AE Courtney, N Leonard, MC McCloskey, JS Smyth, AP Maxwell
Journal Issue: 
Volume 39: Issue 1: 2009




Osteoporosis  and  chronic  kidney  disease  (CKD)  are  both  increasingly prevalent with advancing age. Bisphosphonates are licensed for use in osteoporosis, but the appropriateness and safety of this class of drug in CKD is uncertain. This study assessed the use of bisphosphonates for persons with CKD in clinical practice. The prescribing pattern of bisphosphonates in all 595 persons attending renal services in one UK hospital was analysed. The mean estimated glomerular filtration rate (eGFR) of  the  population  was  44  +  23  ml/min/1.73m2.  Bisphosphonate  treatment  was prescribed  for  32  patients  (5%),  of  whom  13  had  an  eGFR  <30  ml/min/1.73m2 and two  patients  received  maintenance  dialysis  therapy. Thirty-nine  (7%)  patients  were prescribed corticosteroid therapy; 9/23 with an eGFR >30 ml/min/1.73m2 were not
prescribed bisphosphonate medication. Twenty-two (4%) patients had osteoporosis; 5/9  with  an  eGFR  >30  ml/min/1.73m2 were  not  prescribed  bisphosphonate medication.  Bisphosphonate  medication  was  not  prescribed  to  a  proportion  of persons  with  early  CKD  (stages  1–3)  who  could  potentially  benefit  from  such therapy; conversely such treatments were used in some patients with severe CKD (stages  4  and  5). This  pattern  of  bisphosphonate  prescribing  arguably  reflects  the uncertainty about the efficacy and safety of such treatment for persons with CKD.