Antiresorptives in patients with chronic kidney disease with adynamic bone: Is absence of evidence of harm equal to no harm?

We are impressed with the concept discussed by Haarhaus et  al. of using antiresorptives in patients with chronic kidney disease (CKD) with adynamic bone (AB),1 but we need to clarify some concerns. Clinical trials put all patients in 1 group, without stratifying them according to their bone turnover. The impressive response to antiresorptives in patients with high-turnover bone disease might mask their potential harm in patients with AB. Antiresorptives with mild AB might not be harmful, but what about in patients with severe hypoparathyroidism and profound AB? No studies have investigated the impact of antiresorptives specifically in patients with AB who have CKD.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Letter to the Editor Source Type: research