Bisphosphonate Use in Patients Undergoing Dialysis

Bisphosphonates are efficacious for a variety of antiosteoporotic endpoints, most notably for vertebral, nonvertebral, and hip outcomes, including fractures. Currently the prevalence of osteoporosis in patients undergoing dialysis ranges from 13% to 80%. There are very limited data on the use of bisphosphonates within this population. This review discusses the available literature regarding bisphosphonates and dialysis. Contraindication to bisphosphonates, which are cleared renally, can be justifiable based on the pharmacokinetics. However, the medication and dialysis factors that should be considered if bisphosphonates are used in these patients include the amount of drug removed per dialysis session, the molecular weight, the percent protein-bound, sieving coefficient, dialysis membrane, blood-flow rates, and dialysis-flow rates.In addition, much data on bisphosphonates and dialysis are derived from nonosteoporosis studies. Furthermore, a large portion of patients requiring dialysis are at risk for osteoporosis and subsequent fractures, and may benefit from use of bisphosphonates. However, with a dearth of knowledge, more data are needed prior to making this a routine recommendation.