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Archives of Osteoporosis

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01-12-2021 | Osteoporosis | Review Article

Denosumab in chronic kidney disease: a narrative review of treatment efficacy and safety

Authors: Aquila Gopaul, Tharsan Kanagalingam, Jenny Thain, Tayyab Khan, Andrea Cowan, Nabil Sultan, Kristin K. Clemens

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

People with chronic kidney disease (CKD) are at high risk of bone fractures. In this review, we summarize the complexity of fracture prevention in CKD, describe the usefulness of a medication called denosumab, and review its safety in this population. Our article will help doctors manage brittle bones in CKD and encourage researchers to conduct more studies to improve bone health in CKD.

Purpose

Patients with CKD are at increased risk of fragility fractures and associated consequences. We discuss the complexity of fracture prevention in CKD, summarize the efficacy and safety of denosumab, and provide an approach to denosumab-induced hypocalcemia.

Methods

Using predefined terms, we searched PubMed, MEDLINE, and Google Scholar for studies on fracture prevention in CKD and the efficacy and safety of denosumab. We included observational studies, randomized controlled trials (RCTs), meta-analyses, evidence-based reviews, and clinical practice guidelines.

Results

The diagnosis of osteoporosis and prevention of related fragility fractures is complex in CKD, particularly in those with advanced and end-staged kidney disease (ESKD). Prior to initiating denosumab, it is important to assess for and optimize CKD–mineral and bone disorders (CKD-MBD). In observational studies and small RCTs, denosumab has been shown to improve bone mineral density and reduce bone turnover in CKD, but there have been no studies focused upon its fracture efficacy. Denosumab-induced hypocalcemia has also been reported, which disproportionately impacts those with ESKD. Risk factors for hypocalcemia with denosumab use in CKD include lower baseline serum calcium and 25 hydroxyvitamin D and both low and high bone turnover. Choosing the “right patient” for denosumab, supplementing with calcium and vitamin D, adjusting calcium dialysate, and close clinical monitoring are essential if considering this drug.

Conclusion

With optimization of CKD-MBD, calcium and vitamin D supplementation, and close monitoring, denosumab can be considered in CKD. There are however opportunities to better understand its fracture efficacy and safety in an RCT setting.

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Title: Denosumab in chronic kidney disease: a narrative review of treatment efficacy and safety
Authors: Aquila Gopaul
Tharsan Kanagalingam
Jenny Thain
Tayyab Khan
Andrea Cowan
Nabil Sultan
Kristin K. Clemens
Publication date: 01-12-2021
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Chronic Kidney Disease
Hypocalcemia
Denosumab
Denosumab
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-00971-0

At a glance: The STEP trials

Springer Medicine

Denosumab in chronic kidney disease: a narrative review of treatment efficacy and safety

Abstract

Summary

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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