• In the main, bisphosphonates are not metabolised and are excreted unchanged in urine.
  • Oral bisphosphonates are licensed for the primary and secondary prevention of osteoporotic fractures in patients with creatinine clearance as low as 30-35mL/min.
  • Whilst there are data confirming safety and efficacy in patients with impaired renal function, scarce data exists to support the use of bisphosphonates in patients with chronic kidney disease (CKD) stages 4 and 5, thus more studies are needed.
  • Nephrotoxicity is a potential adverse effect of bisphosphonates; however previous studies of patients with CKD have not shown greater deterioration in kidney function in patients using bisphosphonates compared with control groups.
  • Cases of adynamic bone disease associated with bisphosphonate use have been reported in people with CKD. Patients should be carefully assessed, taking into account any risk factors for adynamic bone disease, prior to initiating bisphosphonate therapy.