Osteoporotic fractures are less common in ESKD patients using phosphate binders: Study

A new study by the team of Ji Eun Kim found that osteoporotic fractures are less common in end-stage kidney disease (ESKD) patients who use phosphate binders. The findings of this study were published in the journal of Nephrology Dialysis and Transplantation.

The patients with end-stage renal disease more frequently face osteoporosis measured from dual-energy X-ray absorptiometry (DXA). This condition is linked to a high incidence of fractures and a high all-cause mortality. In addition to the usual complications of osteoporosis, the end-stage renal disease has an increased risk of osteoporotic fractures in association to mineral and bone disease (MBD). Thus, this study looked into the relationship between osteoporotic fracture in dialysis patients and oral phosphate binders, which are the standard for MBD therapy.

The National Health Insurance database provided data on incident dialysis patients lacking a history of osteoporotic fractures for this study. Based on their initial 1-year prescription profiles, these participants were divided into four groups as non-calcium-based phosphate binder (NCBPB), mixed (calcium and non-calcium-based binders), non-calcium-based phosphate binder (CBPB) and non-phosphate binder (non-user). The incidence of newly onset osteoporotic fractures following a year of dialysis was the main outcome. The secondary outcomes focused on the mortality and cardiovascular events.

Out of the total 69,368 incident dialysis patients, this study assigned 22,326 patients to the NCBPB group, 5020 patients to the CBPB group, 2853 patients to the mixed group, and 39,169 patients non-user groups. The patients who using any kind of phosphate binder had a decreased overall risk of osteoporotic fractures when compared to those who did not use them. Also, when compared to non-users, only the CBPB group had a lower incidence of hip, distal radius and vertebral fractures. This association was observed in a time-dependent fashion, with a decrease in fracture risk of the patients who receive CBPB for 3 to 6 months and ≥ 6 months relative to the patients who receive it for less than three months. Only the CBPB group showed a decreased incidence of cardiac arrest, MACE, and ventricular arrhythmia. In comparison to non-users, all phosphorus binder groups had a relatively lower risk of death. Overall, this study suggests that treating renal osteodystrophy with phosphate binders may be linked to a lower incidence of osteoporotic fractures in patients with end-stage kidney disease, without significantly increasing the risk of cardiovascular events relative to non-users. 

Reference:

Kim, J. E., Park, J., Jang, Y., Kang, E., Kim, Y. C., Kim, D. K., Joo, K. W., Kim, Y. S., & Lee, H. (2024). Oral phosphate binders and incident osteoporotic fracture in patients on dialysis. In Nephrology Dialysis Transplantation. Oxford University Press (OUP). https://doi.org/10.1093/ndt/gfae139