Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease : an open cohort multivariable and propensity score analysis from Funen, Denmark
Ali, M. Sanni (London School of Hygiene and Tropical Medicine. Department of Non-communicable Disease Epidemiology)
Ernst, Martin (University of Southern Denmark. Department of Public Health, Clinical Pharmacology and Pharmacy)
Robinson, Danielle E. (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences)
Caskey, Fergus (University of Bristol. Population Health Sciences)
Arden, N. K (MRC Lifecourse Epidemiology Unit)
Ben-Shlomo, Yoav (University of Bristol. Population Health Sciences)
Nybo, Mads (Odense University Hospital (Dinamarca))
Rubin, Katrine H. (University of Southern Denmark. Department of Health)
Judge, Andrew (MRC Lifecourse Epidemiology Unit)
Cooper, Cyrus (MRC Lifecourse Epidemiology Unit)
Javaid, M. K. (MRC Lifecourse Epidemiology Unit)
Hermann, Anne P. (Odense University Hospital (Dinamarca))
Prieto-Alhambra, Daniel (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Bisphosphonates are contraindicated in moderate-to-severe chronic kidney disease patients. However, they are used to prevent fragility fractures in patients with impaired kidney function, despite a lack of evidence on their effects on bone density in these patients. We demonstrated that Alendronate had a positive effect on bone in these patients. This study aimed to assess the association between alendronate use and bone mineral density (BMD) change in subjects with moderate-severe chronic kidney disease (CKD). We created a cohort of CKD stage 3B-5 patients by linking all DXA-based measurements in the Funen area, Denmark, to biochemistry, national health registries and filled prescriptions. Exposure was dispensation of alendronate and the outcome was annualized percentage change in BMD at the femoral neck, total hip and lumbar spine. Individuals were followed from first BMD to the latest of subsequent DXA measurements. Alendronate non-users were identified using incidence density sampling and matched groups were created using propensity scores. Linear regression was used to estimate average differences in the annualized BMD. Use of alendronate was rare in this group of patients: propensity score matching (PSM) resulted in 71 alendronate users and 142 non-users with stage 3B-5 CKD (as in the 1 year before DXA). Whilst alendronate users gained an average 1. 07% femoral neck BMD per year, non-users lost an average of 1. 59% per annum. The PSM mean differences in annualized BMD were + 2. 65% (1. 32%, 3. 99%), + 3. 01% (1. 74%, 4. 28%) and + 2. 12% (0. 98%, 3. 25%) at the femoral neck, total hip and spine BMD, respectively, all in favour of alendronate users. In a real-world cohort of women with stage 3B-5 CKD, use of alendronate appears associated with a significant improvement of 2-3% per year in the femoral neck, total hip and spine BMD. More data are needed on the anti-fracture effectiveness and safety of bisphosphonate therapy in moderate-severe CKD.
Nota:	Funding: This project was funded by the NIHR HTA (project number or 14/36/02) and supported by the NIHR Biomedical Research Centre, Oxford.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Alendronate ; Bone mineral density ; Chronic kidney disease ; Osteoporosis ; Incidence density sampling ; Propensity score
Publicat a:	Archives of Osteoporosis, Vol. 15 (june 2020) , ISSN 1862-3514

DOI: 10.1007/s11657-020-00746-z
PMID: 32483674

12 p, 944.6 KB

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