From the Guidelines
Alendronate 70 mg once weekly is appropriate for a patient with an eGFR of 56 mL/min/1.73m², and no dose adjustment is needed at this level of kidney function. According to the study by 1, alendronate is considered safe and effective for patients with mild to moderate kidney impairment (eGFR >35 mL/min/1.73m²). The patient should take the medication first thing in the morning with a full glass of plain water, at least 30 minutes before any food, beverage, or other medications. They must remain upright (sitting or standing) for at least 30 minutes after taking it to prevent esophageal irritation. Key considerations for the patient include:
- Taking the medication as directed to minimize potential side effects
- Regular monitoring of kidney function while on this medication
- Reassessing the medication if the patient's kidney function declines significantly (eGFR <35 mL/min/1.73m²), as alendronate is not recommended for patients with severe renal impairment due to lack of safety data and potential risk of drug accumulation. As noted in the study by 1, estimating GFR equations have limitations, but in this case, the patient's eGFR of 56 mL/min/1.73m² is above the threshold for safe use of alendronate.
From the FDA Drug Label
No dosage adjustment is necessary for patients with creatinine clearance 35 to 60 mL/min. Alendronate sodium is not recommended for patients with creatinine clearance less than 35 mL/min due to lack of experience with alendronate in renal failure No dosage adjustment is necessary in patients with creatinine clearance values between 35-60 mL/min Alendronate sodium is not recommended for patients with creatinine clearance less than 35 mL/min.
The patient has an eGFR of 56, which falls within the range of 35-60 mL/min.
- No dosage adjustment is necessary for the patient.
- The recommended dose of Alendronate 70 mg can be administered as directed. 2 2 2
From the Research
Alendronate Use with Reduced Renal Function
- The use of alendronate in patients with reduced renal function is a topic of interest, with several studies investigating its safety and efficacy in this population 3, 4, 5, 6, 7.
- A study published in 2011 found that oral bisphosphonates, including alendronate, are well tolerated and effective in individuals with renal impairment, although further research is needed to confirm these findings 3.
- Another study published in 2015 recommended that osteoporosis patients with severe chronic kidney disease (CKD) and no signs of renal osteodystrophy may be treated with oral bisphosphonates, such as risedronate, with strict monitoring of renal function and parathyroid hormone (PTH) levels 4.
- A 2021 retrospective cohort study found that alendronate use in older patients with reduced renal function was not associated with significant deterioration in renal function or increased incidence of osteoporotic fractures or acute kidney injury 5.
- A review published in 2013 found that bisphosphonates, including alendronate, are generally well tolerated and do not have significant effects on renal function in patients with osteoporosis, although patients with severe renal impairment should be monitored closely 6.
- A 2007 analysis of the Fracture Intervention Trial found that alendronate increased bone mineral density (BMD) and decreased fractures to a similar degree in women with and without reduced renal function, with no increase in adverse events among women with impaired renal function 7.
Specific Considerations for Alendronate 70 mg with eGFR of 56
- The patient's eGFR of 56 falls into the category of moderately impaired renal function.
- According to the studies, alendronate may be safe and effective in patients with moderately impaired renal function, although close monitoring of renal function and PTH levels is recommended 4, 5, 7.
- The 2007 analysis of the Fracture Intervention Trial found that alendronate increased BMD and decreased fractures in women with reduced renal function, including those with an eGFR similar to the patient's 7.