Bisphosphonate therapy in CKD: the current state of affairs.
Bisphosphonate therapy in CKD: the current state of affairs.
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DOI：
10.1097/mnh.0000000000000585
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发表时间：
2020-03
影响因子：
3.2
通讯作者：
Nickolas, Thomas L.
中科院分区：
文献类型：
--
作者：
Damasiewicz, Matthew J.;Nickolas, Thomas L.
关键词：
慢性肾脏疾病（CKD）与矿物质和骨疾病（MBD）的发展相关，包括肾性骨营养不良（ROD）。ROD是一种与骨折风险增加相关的骨强度全球性疾病。使用双膦酸盐降低CKD患者骨折风险仍存在争议。本综述提供了关于双膦酸盐在CKD患者中的安全性和潜在抗骨折益处的文献状态的概要。在患有CKD 3-4和CKD-MBD证据的动物的临床前研究中，双膦酸盐导致骨质改变，从而改善骨强度。在患有和不患有CKD的动物中，骨转换通常降低至相似程度。CKD 3-4患者随机试验的事后分析报告，骨矿物质密度（BMD）增加和骨折复位在CKD患者和非CKD患者中相似。尚无CKD-MBD患者的主要临床试验数据。在无CKD-MBD证据的CKD患者中，应遵循一般人群指南使用双膦酸盐。由于缺乏CKD 4-5D患者的数据和CKD-MBD证据，治疗决策具有挑战性。迫切需要临床研究来提供双膦酸盐在这些队列中的安全性和抗骨折益处的数据。
Chronic kidney disease (CKD) is associated with the development of mineral and bone disorders (MBD), including renal osteodystrophy (ROD). ROD is a global disorder of bone strength that is associated with an increased fracture risk. The use of bisphosphonates for fracture risk reduction in CKD remains controversial. This review provides a synopsis of the state-of-the literature regarding the safety and potential anti-fracture benefits of bisphosphonates in CKD patients. In pre-clinical studies of animals with CKD 3–4 and evidence of CKD-MBD, bisphosphonates resulted in changes in bone quality that improve bone strength. Bone turnover was generally reduced to a similar extent in animals with and without CKD. Post hoc analyses of randomized trials in patients with CKD 3–4 reported increases in bone mineral density (BMD) and fracture reduction that were similar in patients with and without CKD. There are no primary clinical trial data in patients with CKD-MBD. In patients with CKD without evidence of CKD-MBD the use of bisphosphonates should follow general population guidelines. The lack of data for patients with CKD 4–5D and evidence of CKD-MBD makes treatment decisions challenging. Clinical studies are urgently needed to provide data on the safety and anti-fracture benefits of bisphosphonates in these cohorts.