ASN Live Update 2010: Drugs in Osteoporosis and CKD

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.