|ISSN No. 1606-7754 Vol.13 No.2 August 2005|
Osteoporosis in renal failure: How accurate is the diagnosis and is there any role for bisphosphonates?
Hussein Saadi1, Yousef Boobes2, Bassam Bernieh2, Samra Abouchacra2
1Department of Internal Medicine, Faculty of Medicine and Health Sciences, UAE University, and 2Division of Nephrology, Tawam Hospital, General Authority for Health Services for the Emirate of Abu Dhabi
Patients with chronic renal failure (CRF) may be at a particularly increased risk for osteoporosis and its related fractures given the high prevalence of some of the known risk factors for osteoporosis. The challenge is how to accurately make the diagnosis of osteoporosis in subjects with CRF since low bone mineral density and fractures could result from secondary hyperparathyroidism, adynamic bone disease, osteomalacia, as well as osteoporosis. Helpful tests include bone turnover markers and double tetracycline-labeled bone biopsy. In patients with confirmed osteoporosis, preliminary data suggest that bisphosphonates seem to be safe and effective down to glomerular filtration rates of 15 mL/min. Low to moderate doses of vitamin D analogues are also helpful in such patients.
Key words: biphosphonates, osteoporosis, renal failure
Osteoporosis is a complex multifactorial disease that remains asymptomatic until a fracture occurs, and strategies need to be developed to accurately identify “high risk” subjects who may benefit from preventive treatments before fractures occur.
Subjects at high risk for osteoporosis include all postmenopausal women who have one or more additional risk factors for osteoporosis besides menopause such as age above age 65 years, personal history of fracture as an adult, history of fracture in a first-degree adult relative, poor health/frailty, cigarette smoking, low body weight, low calcium intake, alcoholism, and inadequate physical activity.1,2 Other risk factors that are common to both men and women include chronic medical problems such as diabetes mellitus, rheumatoid arthritis, hypogonadism, and chronic corticosteroids use. Patients with chronic renal failure (CRF) may be at a particularly increased risk for osteoporosis and its related fractures given the high prevalence of some of the known risk factors for osteoporosis such as sex hormone deficiency, immobilization, sedentary life style, and treatment with corticosteroids.3,4 Additional risk factors specific for renal failure include uremia, acidosis, and vitamin D deficiency.