NDT Advance Access published online on November 23, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl567
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD)
Department of Internal Medicine, Osaka University School of Medicine, Suita, Japan
Correspondence and offprint requests to: Correspondence and offprint requests to: Takahito Ito, MD, PhD, FASN Department of Internal Medicine, Osaka University School of Medicine, Box A8, 2-2 Yamada-oka, Suita, 565-0871, Japan. Email: i-taka{at}umin.ac.jp
 |
Abstract |
|---|
Background. Recent post hoc analysis proved the efficacy and tolerability of risedronate in osteoporotic patients with renal impairment, but the combination of active vitamin D in chronic kidney disease (CKD) patients taking glucocorticoids remains unknown.
Methods. We conducted a prospective study enroling 114 CKD patients (creatinine clearance 
30 ml/min/1.73 m2) receiving glucocorticoid therapy for 6 months. Eighty-eight subjects who had received active vitamin D (aVD) were randomly assigned to either a group treated with aVD only (group A), or to a group also receiving risedronate 2.5 mg/day (group B). The remaining patients (group C) received risedronate only.
Results. After 1 year 100 subjects were analysed. Risedronate was effective on the lumbar spine, but not on the femoral neck. The lumbar bone mineral density (BMD) significantly increased by 2.8 and 2.5% in groups B and C, respectively, but decreased by 1.0% in group A. Serum N-terminal telopeptides of type I collagen (S-NTX) and bone alkaline phosphatase (ALP) fell significantly in groups B and C at 3 and 6 months, respectively, while in group A S-NTX remained unchanged and bone ALP significantly increased. There was no significant difference between groups B and C regarding BMD and bone markers. The reduction rate of S-NTX (bone ALP) at 6 months predicted the increase in lumbar BMD at 1 year with a sensitivity of 73% (34%) and a specificity of 46.2% (100%).
Conclusions. Risedronate is effective in increasing BMD with or without aVD in CKD patients receiving long-term glucocorticoid therapy. Bone markers are of some use in predicting the response to anti-resorptive therapy.
Keywords: bisphosphonates; bone mineral density; glucocorticoids; osteoporosis; steroids; vitamin D
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. D. Toussaint, G. J. Elder, and P. G. Kerr Bisphosphonates in Chronic Kidney Disease; Balancing Potential Benefits and Adverse Effects on Bone and Soft Tissue Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 221 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Cunningham Bisphosphonates in the renal patient Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1505 - 1507. [Full Text] [PDF]
|
|