Res Sq [Preprint]. 2026 May 18:rs.3.rs-9724722. doi: 10.21203/rs.3.rs-9724722/v1.
ABSTRACT
Background Though bisphosphonates are the gold standard for the treatment of different metabolic bone disorders including osteoporosis for more than five decades, their safety and tolerability in patients with compromised kidney function are not well known. With age-related bone disorders and renal insufficiency becoming more prevalent worldwide, understanding the effect of bisphosphonates on patients with compromised renal function becomes inevitable. This review aims to analyze the clinical data available on safety of bisphosphonates on patients with different levels of renal function. Methods A broad search of PubMed, Wiley Online and the Cochrane Central Register of Controlled Trials was conducted to select randomized controlled trials and clinical trials that evaluated the safety and tolerability of bisphosphonate in patients with different levels of renal function between 2000 and 2026. Results Out of 1388 titles and abstract reviewed, 17 articles were included in the final analysis using PRISMA 2020 guidelines. Despite one trial showing < 2% increase in serum creatinine from baseline, all the other trials proved that bisphosphonates are safe and well tolerated by the patients with transplanted kidney and with compromised kidney function. Meta analysis of the data provided from eligible clinical trials using RStudio indicated that the proportion of serum creatinine that is increased was < 25% from baseline. Further, random effects model (100% (-0.01)) was performed due to high level of heterogeneity and it indicated that ibandronate 27.93%; alendronate 28.58%; risedronate 27.80% and zoledronate 15.69%. The pooled effect shows that kidney damage by bisphosphonates is not statistically significant. Conclusion The evidence from this review suggests that the bisphosphonates are generally well-tolerated with ten trials registering no drug-related withdrawals and other studies showing only very negligible withdrawals due to adverse effects. Even though bisphosphonates are safer to use in compromised renal function i.e., > 30ml/min/1.73m 2 , more cohort studies are required to identify bisphosphonates effects in end stage renal disease (eGFR < 15ml/min/1.73m 2 ).
PMID:42239793 | PMC:PMC13228822 | DOI:10.21203/rs.3.rs-9724722/v1
