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Osteoporosis medication that’s ok with chronic kidney disease
Just learned I have severe osteoporosis. Problem I’m facing is I’ve been focusing a lot of attention to my stage 4 kidney disease and following a strict renal diet - low calcium, low protein diet.
Thus seems to be the opposite of what I’m reading is necessary for bone health. Also I’m going to have to go on a medication and that’s risky because many meds damage kidneys. Anyone else having this situation and if so how did you reconcile needs for improvement in bone density without messing up kidneys.
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I think mostly you will find docs focusing on your renal disease to prevent worsening of your osteoporosis. How long have you had renal impairment? With stage 4 CKD, the kidneys don’t properly regulate calcium and phosphorus, leading to imbalances and disrupting vitamin D metabolism. There is often high levels of PTH, related to phosphate retention and low vitamin D. This causes calcium to to be leeched from bone, increasing bone turnover. All of the above cause structural deterioration of bone, increasing its fragility.
Your kidney doctor is likely already monitoring your calcium, phosphorus, and alkaline phoshatase. Ask him/ her if they think you have high turnover bone disease vs low turnover.
Generally treatment of osteoporosis in your population focuses on managing the renal complications. You likely are on a low phosphorus diet. Use of traditional osteoporosis meds requires careful attention by your doctor, and sometimes the risk/ benefit ratio is not favorable. You can ask about low dose vitamin D. In kidney disease, I’m sure you know, even otc meds must be managed by the doctor. Osteoporosis in stage 4 kidney disease is a hot topic in medical journals. You can find more information on Google scholar.
If you know all this already, I’m sorry to take up space. You can consider seeing an endocrinologist that specializes in osteoporosis, don't be shocked if they defer to your nephrologist.
I found this article, it may be a bit dense but it covers all areas of osteoporosis in renal disease. If it is too hard to follow, just read the abstract and conclusion. I will try to find something meant for laypeople on the NIH website
https://link.springer.com/article/10.1007/s12020-021-02735-9
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1 ReactionAll the NIH papers require you to buy them! Seems unfair since NIH , at least until recently, was sponsored with tax dollars.
The main jist is as follows “the use of osteoporosis medication in the context of advanced stage 4-5 kidney disease is complex and challenging “ and “treatment choices are complex and difficult “.
You might try YouTube