Kidney Week

Abstract: TH-PO730

Bisphosphonate Utilization Across the eGFR Spectrum

Session Information

• Women's Health and Kidney Diseases
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women’s Health and Kidney Diseases

• 2000 Women’s Health and Kidney Diseases

Authors

• Titan, Silvia M., Sao Paulo University Medical School, Sao Paulo, Brazil

Silvia M. Titan,

• Laureati, Paola, Karolinska Institutet, Stockholm, Sweden

Paola Laureati,

• Sang, Yingying, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Yingying Sang,

• Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States

Andrew S. Levey,

• Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States

Alex R. Chang,

• Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States

Morgan Grams,

• Inker, Lesley, Tufts Medical Center, Boston, Massachusetts, United States

Lesley Inker,

• Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden

Juan Jesus Carrero,

Background

KDIGO currently recommends bisphosphonate (BSP) use for osteoporosis patients with CKD G3a-G3b who have normal PTH and high risk of fractures. This study evaluated the frequency and factors associated with BSP use among osteoporosis patients from two healthcare organizations: Geisinger (2006-2017), Pennsylvania, United States; and Stockholm region (2006-2012), Sweden.

Methods

Incident osteoporosis was defined as the first ICD code for osteoporosis, and BSP use was defined as the prescription (Geisinger) or dispensation (Stockholm) of any BSP 6 months prior or up to 3 years following the diagnosis of osteoporosis. BSP use was compared across eGFR categories, accounting for the competing risk of death using multinomial logistic regression.

Results

There were 15887 women and 3200 men in Stockholm and 23645 women and 7026 men in Geisinger with incident osteoporosis. Overall, BSP use was 55% in Stockholm and 36% in Geisinger, with lower rates in the groups with eGFR <45 ml/min/1.73m². After adjustment for age and identified confounders, the odds of BSP prescription dropped progressively with lower eGFR, particularly in those with eGFR<60ml/min/1.73m² (Figure 1). In Geisinger, BSP use declined significantly over time.

Conclusion

Our results suggest that BSP use is not high in incident osteoporosis, with infrequent use in lower eGFR. Although we lacked data on PTH and fracture risk score, this study raises concern about osteoporosis under-treatment in patients with eGFR 30-60ml/min/1.73m².

Figure 1.

Funding

• Other NIH Support