Drugs in Osteoporosis in CKD: Orson Moe, MD
1. Anti reabsorptive agents: Kill osteoclasts
Bisphosphanates: work fast, blasts slow down and increase bone quantity but turnover is reduced ( so not a good option for someone with Adynamic bone disease). Usually contraindicated in GFR<30. If you have CKD stage 3 and you have a low DEXA and aydnamic bone disease and get a bisphosphanate, now hyou have zero turnover more fractures.
HRT/SERM: inhibit osteoclast proliferation and function, again leading to low turnover
Calcitonin: doesn’t completely kill osteoclast, the balance of blasts is maintained. Not widely used though.
Anti RANKL M ab: data on CKD lacking and transplant no experience
2. Osteo anabolic agents
Pth: pulse pth, data on CKD not very strong
Strontium, IGF-1 and other s in pipeline
Best agents in CKD: Calcicum, Vitamin D, Exercise and dietary acid lowering.
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