Renal safety in patients treated with bisphosphonates for osteoporosis: a review.

Abstract

Bisphosphonates are widely used for the treatment of osteoporosis and are generally well tolerated. However, the United States Food and Drug Administration safety reports have highlighted the issue of renal safety in bisphosphonate-treated patients. All bisphosphonates carry labeled "warnings" or a contraindication for use in patients with severe renal impairment (creatinine clearance <30 or <35 mL/min). Data from pivotal trials and their extension studies of bisphosphonates approved for the management of osteoporosis were obtained via PubMed, and were reviewed with support from published articles available on PubMed. Renal safety analyses of pivotal trials of oral alendronate, risedronate, and ibandronate for postmenopausal osteoporosis showed no short-term or long-term effects on renal function. Transient postinfusion increases in serum creatinine have been reported in patients receiving intravenous ibandronate and zoledronic acid; however, studies showed that treatment with these agents did not result in long-term renal function deterioration in clinical trial patients with osteoporosis. All bisphosphonate therapies have "warnings" for use in patients with severe renal impairment. Clinical trial results have shown that even in elderly, frail, osteoporotic patients with renal impairment, intravenous bisphosphonate therapy administration in accordance with the prescribing information did not result in long-term renal function decline. Physicians should follow guidelines for bisphosphonate therapies administration at all times.

• Authors: Paul D Miller, Sophie A Jamal, Pieter Evenepoel, Richard Eastell, Steven Boonen
• Journal: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research (J Bone Miner Res) Vol. 28 Issue 10 Pg. 2049-59 (Oct 2013) ISSN: 1523-4681 [Electronic] United States
• PMID: 23907861 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: © 2013 American Society for Bone and Mineral Research.

Chemical References

• Diphosphonates

Topics

• Diphosphonates (adverse effects, therapeutic use)
• Humans
• Kidney (drug effects, physiopathology)
• Kidney Function Tests
• Osteoporosis (drug therapy, physiopathology)
• Product Surveillance, Postmarketing