Denosumab in chronic kidney disease: a narrative review of treatment efficacy and safety.
Study Goal
The researchers aimed to evaluate the efficacy and safety of denosumab in preventing fractures in patients with chronic kidney disease (CKD), including its impact on bone mineral density and hypocalcemia risks.
Results Summary
Denosumab improved bone mineral density and reduced bone turnover in CKD patients, but its fracture efficacy remains unstudied. Hypocalcemia was a notable adverse effect, particularly in end-stage kidney disease (ESKD) patients, with risk factors including low baseline calcium and vitamin D levels.
Population
Patients with chronic kidney disease (CKD), particularly those with advanced or end-stage kidney disease (ESKD).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
denosumab | increase | bone mineral density | CKD | - | has been shown to improve | #1 |
denosumab | decrease | bone turnover | CKD | - | reduce | #2 |
denosumab | increase | hypocalcemia | those with ESKD | - | has also been reported | #3 |
UNLABELLED: 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.