Therapy for Patients with CKD and Low Bone Mineral Density

http://www.ncbi.nlm.nih.gov/pubmed/24100401

Nat Rev Nephrol. 2013 Nov;9(11):681-92. doi: 10.1038/nrneph.2013.182. Epub 2013 Oct 8.

Patients with chronic kidney disease (CKD) have a high risk of bone fracture owing to their low bone mineral density, which resembles that of postmenopausal osteoporosis. However, the mineral and bone disorder associated with CKD (CKD-MBD) is more complex than osteoporosis and the same treatments might not be appropriate. In particular, vascular calcifications are strongly associated with CKD-MBD, and must be taken into consideration. Post hoc analyses of data from pivotal osteoporosis studies suggest that in patients with mild stage 3 CKD and normal parathyroid hormone (PTH), calcium and phosphate measurements, conventional medications for osteoporosis (such as raloxifene, bisphosphonates, teriparatide and denosumab) are effective at reducing fracture rates. However, for patients with stage 4-5 CKD, or those with abnormal PTH and mineral values, the available data are insufficient to determine whether these commonly used medications are effective against fractures. Moreover, all medications used to treat osteoporosis have known or potential adverse effects in patients with CKD. Medicines that increase bone formation by upregulating Wnt signalling have shown promise in patients with osteoporosis and might be used to treat CKD-MBD in the future, but off-target effects could limit their use in in this setting. 

Hip Fracture Risk and Antihypertensive Drugs

Are you taking strontium citrate or one of the osteoporosis medications to increase your BMD and decrease your bone fracture risk? Here is something else to consider if you are at least 66 years of age. 
 
Initiating antihypertensive drugs in the elderly has been associated with an immediate increased risk of falls. The most likely mechanism is orthostatic hypotension, which is associated with dizziness and fainting. The effect is acute, occurs over a relatively short time, and may lead to falls, some of which can result in hip fractures.

The following study was undertaken to determine whether initiation of antihypertensive drugs (e.g., thiazide diuretics, angiotensin II converting–enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, or β-adrenergic blockers) was associated with an immediate increased risk of hip fractures. Health care administrative databases were used to identify patients initiating an antihypertensive drug in Ontario, Canada. Elderly  people who began receiving an antihypertensive drug had a 43% increased risk of having a hip fracture during the first 45 days following treatment initiation.

http://archinte.jamanetwork.com/article.aspx?articleid=1392493

http://www.medscape.com/viewarticle/774769?src=mpnews