ArticleBMC geriatrics2025
The effect of bisphosphonates on kidney function in osteoporotic geriatric patients with impaired renal function.
Article in BMC geriatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBisphosphonates are a mainstay treatment for osteoporosis, with prescribing guidelines based on creatinine clearance (CrCl). However, clinicians often use the estimated glomerular filtration rate (eGFR) from the CKD-EPI equation, which can lead to prescribing discrepancies in older adults, particularly in resource-limited settings where these agents are first-line therapy.
objectivesTo evaluate the real-world renal safety of bisphosphonates in older adults with discrepant renal function estimates (eGFR ≥ 35 mL/min/1.73 m² vs. CrCl < 35 mL/min) and assess renal function changes over 12 months.
methodsA retrospective cohort study was conducted in osteoporotic geriatric patients, all of whom had a baseline eGFR between 35 and 60 mL/min/1.73 m². These patients were then categorized into two groups based on their calculated CrCl: a CrCl < 35 mL/min group and a CrCl ≥ 35 mL/min group. Renal function was assessed at baseline, month 3, 6 and 12. The primary outcome was the change in renal function over time, analyzed using generalized estimating equations (GEE) with a group × time interaction term.
resultsA total of 222 patients (190 [85.6%] female; mean age 80.0 ± 6.5 years) were analyzed, with 109 (49.1%) in the CrCl < 35 group and 113 (50.9%) in the CrCl ≥ 35 group. Over the 12-month follow-up, the trajectories of renal function change—as measured by serum creatinine, eGFR, BSA-adjusted eGFR, and CrCl—did not significantly differ between the two groups (all p-values for interaction > 0.05). However, the CrCl < 35 group had a significantly higher adjusted relative risk (RR) of renal-related adverse events at 6 months (adjusted RR 6.77, 95% CI: 1.53 to 29.88) and 12 months (adjusted RR 3.75, 95% CI: 1.04 to 13.50).
conclusionsCalculating CrCl is essential before initiating bisphosphonate therapy in older adults. While long-term renal function trajectories were stable, the increased risk of acute adverse events in patients with CrCl < 35 mL/min underscores the need for careful monitoring. These findings suggest that bisphosphonates may be used cautiously in selected patients with impaired renal function, especially in resource-limited settings.
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