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  Friday, 12 October 2018
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Can medicines used to strengthen bones lower kidney function? If so, which ones do and which ones do not?

I am a 64-year-old female taking anastrozole as a result of a double mastectomy for breast cancer. I have also had an ESWL to remove a kidney stone, and my GFR has been stable at around 50 for several years. I was also diagnosed with osteoporosis through a DEXA scan and am now faced with choosing a medicine to strengthen my bones.

I would like to select the medication that will best help my bones, while at the same time protecting my kidneys from damage. Please help. Thanks!
Hello there,

Osteoporosis medications are not generally harmful to the kidneys. However, in patients with reduced kidney function - depending on the degree of reduction - some medications have to be dose-reduced or avoided altogether to minimize the side effects and to prevent prolonged retention of the drug within the bone. At a GFR of 50 ml/min, most drugs such as the bisphosphonates or a newer agent Denosumab (Prolia) would not need to be dose-reduced at that level of GFR.

Dr. Jordan Weinstein
5 years ago
Thank you for your quick response! My doctor told me that I could choose any medicine and to choose it based on the method of delivery (pill, shot, IV, etc.). I will tolerate any of the methods and would really like to choose based on kidney protection and effectiveness for the bones, as well as avoiding long-term side effects. Of Fosamax, Prolia, and Reclast, which do you feel would be best for protecting kidneys, improving bone strength, and having the fewest long-term side effects?

In this case, the question is really about the medication that is most convenient and efficacious for your osteoporosis. I am not an expert in his condition but do have to know when certain medications for any condition need to be modified based on kidney function. Osteoporosis medications are an example of that. But as to which one is best for you, that is really up to you and your treating physician.

Sorry that I'm not more helpful with that decision.

Dr. Jordan Weinstein
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