Effects of Clodronate in Severe Hyperparathyroid Bone Disease in Chronic Renal Failure

Hamdy, Neveen A. T.; McCloskey, EV; Brown, Christine; Kanis, John А.

doi:10.1159/000186092

Cited by 22 publications

(4 citation statements)

References 23 publications

(28 reference statements)

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“…Clinically, the affinity of bisphosphonates to bone in dialysis patients is related to the degree of HPT, although bisphosphonate effects in patients with CKD‐5D have only been examined in a limited number of studies. Administration of clodronate in nine HD patients with severe HPT produced inhibition of osteoclast‐mediated bone resorption (91) and in a RCT of 31 HD patients, hip BMD remained stable after 6 months in patients treated with alendronate compared to a reduction in those on placebo (92). However, in the latter study this difference was minimal (despite statistical significance) and the treatment time was short.…”

Section: Treatment Optionsmentioning

confidence: 99%

A Rational Guide to Reducing Fracture Risk in Dialysis Patients

Toussaint

Elder

Kerr

2010

Seminars in Dialysis

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Extrapolation of evidence-based management of disorders in the general population to patients with chronic kidney disease (CKD) is not always appropriate, and the prevention of bone fracture and reduction of fracture risk in CKD stages 3-5 is one example. Compared to the general population, fracture risk is greater in CKD patients, especially those on dialysis (CKD-5D). Fractures in CKD-5D are associated with a marked increase in morbidity and mortality and with an aging dialysis population the burden of disease caused by fracture is likely to increase. Patients with CKD-5D have distinct risks for fracture, as well as sharing risks identified in the general population. The development of the CKD mineral and bone disorder constitutes a significant cause for these differences. Literature addressing the determination of fracture risk and the efficacy of treatments to reduce fracture in patients on dialysis is limited. While some tools used for the diagnosis and monitoring of osteoporosis are applicable to patients on dialysis, bone mineral density measurement by dual-energy X-ray absorptiometry is generally not helpful and therapeutic interventions that reduce fracture risk in the nonuremic population cannot be generalized to patients on dialysis. This review outlines available evidence on the incidence, risk factors, and management of fractures in CKD-5D with recommendations for strategies to reduce fracture risk.

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Section: Treatment Optionsmentioning

confidence: 99%

A Rational Guide to Reducing Fracture Risk in Dialysis Patients

Toussaint

Elder

Kerr

2010

Seminars in Dialysis

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“…In experimental renal failure, ibandronate prevents hyperparathyroid bone changes and increases bone volume [65]. Clodronate given after hemodialysis induces a significant decrease in serum calcium levels and interestingly an increase of parathyroid hormone in hemodialysis patients [66]. Elimination of ibandronate in patients on hemodialysis has been studied and ibandronate was shown to be efficiently removed by hemodialysis.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Osteoporosis in the elderly with chronic kidney disease

Ersoy

2006

Int Urol Nephrol

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Considering the aging dialysis population of today, increasing our knowledge about the nature, diagnosis and the treatment of bone mineral density (BMD) problems in end-stage renal disease (ESRD) patients deserves more attention. Osteoporosis is basicly defined as a decrease in bone mass. Large epidemiological studies in general population have identified several risk factors for osteoporosis including advancing age, female gender, white race, decreased calcium intake, gastric acid suppression therapy, sedentary lifestyle, premature loss of gonadal function, decreased estrogen secretion, thin body habitus, decreased physical activity, cigarette smoking, alcohol abuse, excess glucocorticoid exposure, and possibly some genetic factors. Osteoporosis in ESRD patients is only a part of a wider spectrum of metabolic bone problems, namely uremic osteodystrophy. Therefore, its diagnosis, management and follow-up may differ from the general population and an individualization of diagnosis and definition for dialysis population may be necessary. However, standard diagnostic tools such as dual energy X-ray absorptiometry (DEXA) have been widely used for the assessment of bone mineral deficiency status in ESRD patients. Regardless of the methods, most of the studies are in concordance with a reduced BMD in HD and PD patients. Dialysis patients are known to be at increased risk for low-trauma fractures. Thinning of cortical bone, which is responsible for the largest contribution toward reduced bone mineral content in chronic renal failure results in increased fracture risk. In either normal population and dialysis patients, fracture risk is increased with age. But in dialysis patients, besides age, several other factors may also affect the degree of bone mineral deficiency, and age-BMD relationship may be blunted. Female sex, in hemodialysis patients is negatively associated with total hip BMD. While several studies have been unable to demonstrate any association between BMD and PTH levels, larger body size has been shown to have a significant positive effect on BMD in both hemodialysis and peritoneal dialysis patients. Although they have been used in small groups of chronic kidney disease (CKD) and ESRD patients, because of their potential nephrotoxicity and hypocalcemic effects, use of biphosphonates in renal patients is questionable. Currently, bone biopsy, in order to exclude adynamic bone disease is recommended before beginning treatment with bisphosphonates in chronic kidney disease and dialysis patients.

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“…They are widely used to treat postmenopausal or glucocorticoid-induced osteoporosis, but little evidence is available on their effectiveness and safety in patients on HD. Previous studies reported that BPs were a potential treatment for renal osteodystrophy, particularly in patients with high bone turnover or hypercalcemia related to increased release of calcium from bone [ 11 , 12 ], and that they may be beneficial in HD patients [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis

et al. 2021

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Background No publications have reported on osteomalacia in patients receiving intermittent cyclical therapy with etidronate (a bisphosphonate) and undergoing long-term hemodialysis (HD). Case presentation We report on a 46-year-old Japanese man admitted to our hospital for further examination of left forearm pain. Maintenance HD was started at age 24 years, and the man had been on HD since then. At age 38 years, surgical parathyroidectomy was performed for secondary hyperparathyroidism; iliac crest bone biopsy performed at the same time showed osteitis fibrosa. The active vitamin D3 preparation calcitriol was started, and intermittent cyclical etidronate therapy was introduced 2 years later for osteoporosis. At age 45 years, the patient stopped taking calcitriol because of hypercalcemia but continued with etidronate. At age 46 years, a pseudofracture with a Looser zone occurred in the left ulna, and left femur bone biopsy revealed osteomalacia. Etidronate was discontinued, and calcitriol was restarted; open reduction and internal fixation with an angular stability plate were performed. Union of the bone was achieved 10 months after the operation. At age 49 years, a lumber bone biopsy confirmed improved bone morphometry. Conclusions We believe that intermittent cyclical etidronate therapy without administration of active vitamin D3 during long-term HD might have induced osteomalacia, resulting in the ulna insufficiency fracture. Therefore, we propose that administration of active vitamin D3 is essential to prevent osteomalacia in patients on long-term HD who are receiving bisphosphonates and have potential vitamin D3 deficiency.

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Effects of Clodronate in Severe Hyperparathyroid Bone Disease in Chronic Renal Failure

Cited by 22 publications

References 23 publications

A Rational Guide to Reducing Fracture Risk in Dialysis Patients

A Rational Guide to Reducing Fracture Risk in Dialysis Patients

Osteoporosis in the elderly with chronic kidney disease

Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis

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