Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management

Table 1

The manufacturer’s recommendations for the use of currently approved osteoporosis therapies in renal impairment.

Osteoporosis therapy	Creatinine (mmols/L)	CrCL (mL/min)
Alendronate		>35
Risedronate		>30
Zoledronic acid		>35
Ibandronate		>50—for CrCL below 50; manufacturer advises reduction in dose
Raloxifene		Dose adjustment not required
Strontium ranelate		>30
Denosumab		>30—for CrCL below 30 or receiving dialysis; manufacturer warns of risk of hypocalcaemia
Teriparatide	<177
Calcitonin		Mild dose adjustment in renal impairment