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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Use of Oral Bisphosphonates by Older Adults with Fractures and Impaired Renal Function
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Use of Oral Bisphosphonates by Older Adults with Fractures and Impaired Renal Function

机译：骨折和肾功能受损的老年人使用口服双膦酸盐

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Background: The manufacturers of oral bisphosphonates (alendronate, risedronate) recommend avoiding use of these drugs in patients with renal impairment. However, many patients who have osteoporosis or who are at risk of fracture are elderly and may have renal impairment. This situation poses a quandary for clinicians in deciding how best to manage osteoporosis in this high-risk population.Objective: To synthesize published evidence regarding the use and safety of oral bisphosphonates for patients with impaired renal function.Methods: The following databases were searched up to October 2010: PubMed, MEDLINE, Embase, the Cochrane Library, and International Pharmaceutical Abstracts. The following key words and terms were used for the searches: bisphosphonates, alendronate, risedronate, Fosamax, Actonel, "renal failure", "renal insufficiency", "chronic kidney disease", and "end-stage renal disease". The manufacturers of Fosamax and Actonel were asked to provide information about use of their products in patients with renal impairment, including unpublished pharmaco-kinetic studies or reports of adverse drug events.Results: The search yielded 2 post hoc analyses of safety data, 1 case-control study, 1 case series, 4 retrospective chart analyses, and 2 prospective studies. According to these publications, numerous patients with decreased renal function have received bisphosphonates and have experienced improvement in bone mineral density and/or reduction in risk of fractures, with no increase in adverse effects. Increased renal damage occurred in some individuals with underlying renal disorders, as described in case reports.Conclusions: Although the literature is limited, there is evidence that alendronate and risedronate are well tolerated and effective when used by individuals with renal impairment. Further research is required to confirm the benefits and risks of using these medications in patients with renal impairment.
机译：背景：口服双膦酸盐（阿仑膦酸盐，利塞膦酸盐）的制造商建议在肾功能不全的患者中避免使用这些药物。但是，许多患有骨质疏松症或有骨折风险的患者都是老年患者，可能患有肾功能不全。这种情况对于临床医生决定如何在这个高风险人群中更好地管理骨质疏松症感到困惑。目的：合成有关肾双功能障碍患者口服双膦酸盐的使用和安全性的公开证据方法：检索以下数据库至2010年10月：PubMed，MEDLINE，Embase，Cochrane图书馆和国际药物文摘。搜索使用了以下关键词和术语：双膦酸盐，阿仑膦酸盐，利塞膦酸盐，福萨莫斯，Actonel，“肾衰竭”，“肾功能不全”，“慢性肾脏病”和“终末期肾脏病”。要求Fosamax和Actonel的制造商提供有关其产品在肾功能不全患者中使用的信息，包括未发表的药代动力学研究或不良药物事件的报告。结果：该搜索产生了2个事后安全数据分析，其中1例对照研究，1个病例系列，4个回顾性图表分析和2个前瞻性研究。根据这些出版物，许多肾功能下降的患者接受了双膦酸盐治疗，并且骨矿物质密度得到改善和/或骨折风险降低，而副作用没有增加。如病例报告所述，在一些潜在的肾脏疾病个体中发生的肾脏损害增加。结论：尽管文献有限，但有证据表明，当肾功能不全的个体使用阿仑膦酸盐和利塞膦酸盐时，耐受性良好且有效。需要进一步的研究来确定在肾功能不全患者中使用这些药物的益处和风险。

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