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Abstract: SA-PO183

Ten Years' Experience Treating Osteoporosis in Hemodialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Sakai, Kentaro, Our Lady of the Snow Social Medical Corporation St. Mary's Hospital, Kurume, Fukuoka, Japan
  • Fukami, Kei, Kurume Daigaku, Kurume, Fukuoka, Japan

The treatment of osteoporosis in hemodialysis (HD) patients has not been established, as there is insufficient evidence regarding the treatment of osteoporosis. We began treating osteoporosis in HD patients in 2011. Herein, we describe the effects of the treatment based on our 10-year experience.


This was a single-center prospective observational study of 141 HD patients (age 73.9±11.4 yrs; 77 females) treated for osteoporosis from 2011 to 2021. The average observational period was 4.8±2.9 years. We introduced osteoporosis treatment with alendronate in 2011, ibandronate in 2016, and denosumab in 2018. The patients' BMD values including the lumbar spine, femoral neck, and total hip were determined by dual-energy X-ray absorptiometry. We have administered alendronate or ibandronate to patients whose first T-score was ≤-2.5. Beginning in 2018, if a patient's T-score did not improve after the second year, we changed the medication to denosumab. The patients' yearly values of bone metabolism markers such as parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase 5b (TRACP-5b) were assessed.


In the alendronate group (n=79), the lumbar spine BMD was significantly improved at 1 year (−3.2±1.0 vs −2.9±0.9, p<0.05), but this BMD did not improve after the second year. In the denosumab group (n=40), the femoral neck BMD has improved significantly since the second year (−2.9±0.8 vs. −2.5±0.6, p<0.05). Serum calcium decreased significantly only in the denosumab group after the start of treatment (8.5±0.6 vs. 7.8±0.9 mg/dL, p<0.01). The PTH level was unchanged during the study period in each group, but the BAP and TRACP-5b levels decreased significantly in the denosumab group (p<0.01). A multivariate analysis demonstrated that a low baseline BMD was significantly associated with BMD improvement in the alendronate group (OR 11.08, 95%CI: 2.67–41.00, p<0.01).


The results of this long-term study suggest that the treatment of osteoporosis with the above-mentioned drugs may be effective in patients undergoing HD. Alendronate may be effective the first year, but its effect may not continue after the second year. Although denosumab can decrease serum calcium, it may be more effective than alendronate and ibandronate (especially after the second year).