Letters To The Editor

Fragility fractures in chronic kidney disease: A clarification of views

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To the Editor: I was pleased to see my article on fragility fractures in patients with chronic kidney disease (CKD) in the Cleveland Clinic Journal of Medicine 1 and your preamble Letter from the Editor. 2

However, Dr. Coco’s accompanying editorial 3 misquoted a particular point I cautiously and consistently make—not only in the CCJM article, but in other invited papers on the topic of fractures in CKD. I specifically state that bisphosphonates should only be considered in stage 4–5 CKD in fracturing patients, not just those with “low bone mineral density,” who have clear-cut osteoporosis by exclusion of other causes of fractures in this population. Hence, Dr. Coco’s statement that “… the author advocates the use of bisphosphonate therapy in patients with chronic kidney disease who have low bone mineral density” is inaccurate.

If one carefully reads the last four paragraphs of my paper on page 721, one will see that I emphasize this caution repeatedly and even specifically state: “Treating only on the basis of low bone mineral density and other risk factors seems to be associated with greater risk than benefit.”

Thank you for your consideration.

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