The efficacy and safety of bisphosphonate for patients with kidney disease

: Bisphoshonate is largely used for treatment of osteoporosis in general population. The gastrointestinal absorption is poor and it can be excreted via only kidney. Therefore, CKD patients can accumulate a higher dose of bisphosphonate in their body. Although the primary action of bisphosphonate is the inhibition of bone resorption, it secondary suppresses bone formation, which can often lead to adynamic bone disease in patients with CKD. In CKD patients who still have normal parathyroid hormone, calcium, and phosphate levels, randomized trials showed the similar effects as in non-CKD patients;however, in patients with CKD stage 4 and dialysis patients, data are very limited and the benefits and safety has remained unclear. In several small clinical researches, etidronate has reduced vessel calcifications, but this has not been yet proved in a large randomized study.