title: Prevalence of renal impairment among osteoporotic women in the USA, NHANES 2005-2008: is treatment with bisphosphonates an option?
abstract: Bisphosphonates are the first-line treatment for osteoporotic (OP) women; however, therapy is not recommended in severe renal impairment (RI). This study examined RI prevalence among OP women. Nearly a quarter of women had moderate RI, and 3.59% would not be recommended for bisphosphonates, demonstrating a need for better therapeutic alternatives.
  
  
  BACKGROUND
  Bisphosphonates are the recommended first-line treatment for postmenopausal women with OP. However, bisphosphonates are cleared through the kidney, and therapy is not recommended in severe RI due to adverse treatment effects observed with intravenous formulations. The objective of this study was to examine the prevalence of RI among women with OP aged ≥50 years in the USA.
  
  
  METHODS
  Women with OP aged ≥50 years were identified using the 2005-2008 National Health and Nutrition Examination Survey (NHANES) data. OP was defined as prior OP diagnosis, previous hip or spine fracture, or measured lumbar spine/femoral neck bone mineral density (BMD) T-score <-2.5. The 2005 Modification of Diet in Renal Disease (MDRD) formula was used to calculate the glomerular filtration rate (GFR). Moderate and severe RI was defined as GFR 30-59 and 15-29 mL/min, respectively. Bisphosphonate therapy was considered not recommended among women with OP if GFR was <35 mL/min.
  
  
  RESULTS
  The prevalence of OP among women in USA aged ≥50 years was 27% (12.7 million). Nearly a quarter of women with OP (23.54 ± 2.02%; 2.9 million) had moderate RI and 1.88 ± 0.28% (230,000) had severe RI. Correspondingly, bisphosphonate therapy would not be recommended for an estimated 439,000 women with OP (3.59 ± 0.73%).
  
  
  CONCLUSIONS
  Nearly a quarter of postmenopausal women with OP have moderate RI, and over 3% would not be recommended for bisphosphonate treatment. These data reveal a need for better therapeutic alternatives that can be used in this patient population.
authors.affiliation: Epidemiology, Merck & Co Inc, New Jersey, USA, robert_Lubwama@merck.com.
authors.forename: R
authors.initials: R
authors.lastname: Lubwama
authors.forename: A
authors.initials: A
authors.lastname: Nguyen
authors.forename: A
authors.initials: A
authors.lastname: Modi
authors.forename: D
authors.initials: D
authors.lastname: Chirovsky
authors.forename: C
authors.initials: C
authors.lastname: Diana
authors.forename: P D
authors.initials: PD
authors.lastname: Miller
mesh_terms: D000368:Aged; D015992:Body Mass Index; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D000075202:Contraindications; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates