Safety of Oral Bisphosphonates in Patients With Moderate-to-severe CKD

Sarfaroj Khan 


February 04, 2021


  • Bisphosphonate use was associated with a modest increase in the risk of chronic kidney disease (CKD) progression in patients with moderate-to-severe CKD (stage IIIb-V).

  • No association was seen between bisphosphonate use and acute kidney injury, gastrointestinal (GI) events or hypocalcaemia.

Why this matters

  • Bisphosphonates, which are currently contraindicated or used with caution in patients with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 should continue to be used with caution in this population.

Study design

  • This study included patients with moderate-to-severe CKD (eGFR <45 mL/min/1.73m2; age, ≥40 years) from the UK Clinical Practice Research Datalink (CPRD; 1997-2016) and Catalonia’s Information System for the Development of Research in Primary Care (SIDIAP; 2007-2015).

  • 2447 bisphosphonate users were propensity score matched with 8931 non-users from CPRD and 1399 users with 6547 non-users from SIDIAP.

  • Primary outcome: CKD stage worsening.

  • Funding: National Institute of Health Research Health Technology.

Key results

  • Bisphosphonate use was associated with an increased risk of CKD progression in CPRD (HR, 1.14; 95% CI, 1.04-1.26) and SIDIAP (HR, 1.15; 95% CI, 1.04-1.27); combined HR, 1.14; 95% CI, 1.07-1.23.

  • No risk differences were observed for:

    • acute kidney injury (combined HR, 0.92; 95% CI, 0.78-1.08);

    • GI bleeding/ulcers (combined HR, 0.97; 95% CI, 0.70-1.33); and

    • hypocalcaemia (HR, 0.34; 95% CI, 0.08-1.43) in CPRD.


  • Risk of confounding.


Robinson DE, Ali MS, Pallares N, Tebé C, Elhussein L, Abrahamsen B, Arden NK, Ben-Shlomo Y, Caskey FJ, Cooper C, Dedman D, Delmestri A, Judge A, Pérez-Sáez MJ, Pascual J, Nogues X, Diez-Perez A, Strauss VY, Javaid MK, Prieto-Alhambra D. Safety of oral bisphosphonates in moderate-to-severe chronic kidney disease: a bi-national cohort analysis. J Bone Miner Res. 2020 Dec 29 [Epub ahead of print]. doi: 10.1002/jbmr.4235. PMID: 33373491.  View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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