Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD).
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 enrolling 114 CKD patients (creatinine clearance > or =30 ml/min/1.73 m(2)) receiving glucocorticoid therapy for > or =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.
Fujii
Naohiko
N
FASN Department of Internal Medicine, Osaka University School of Medicine, Box A8, 2-2 Yamada-oka, Suita 565-0871, Japan.
Hamano
Takayuki
T
Mikami
Satoshi
S
Nagasawa
Yasuyuki
Y
Isaka
Yoshitaka
Y
Moriyama
Toshiki
T
Horio
Masaru
M
Imai
Enyu
E
Hori
Masatsugu
M
Ito
Takahito
T
D000328:Adult; D050071:Bone Density Conservation Agents / Q000494:pharmacology*; D001862:Bone Resorption / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D011239:Prednisolone / Q000009:adverse effects* / Q000494:pharmacology; D011446:Prospective Studies; D000068296:Risedronic Acid; D014807:Vitamin D / Q000031:analogs & derivatives / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D014807:Vitamin D; D011239:Prednisolone; D000068296:Risedronic Acid; D012968:Etidronic Acid