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Bazedoxifene improves renal function and increases renal phosphate excretion in patients with postmenopausal osteoporosis

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Abstract

Introduction

Because aging is a predictor of renal insufficiency in the general population, renal function is a concern in postmenopausal patients undergoing treatment for osteoporosis. Although high serum phosphate concentration is a predictor of renal insufficiency, the effect of selective estrogen receptor modulator (SERM) on renal function and phosphate homeostasis remains to be established.

Materials and Methods

We administered 20 mg/day bazedoxifene to 48 postmenopausal osteoporotic women who had been taking alfacalcidol for ≥ 6 months, and assessed lumbar spine bone mineral density (LS-BMD), renal function (by calculating estimated glomerular filtration rate using serum cystatin-C levels [eGFRcys] [range 38.0–98.2 mL/min/1.73 m2]), and phosphate homeostasis.

Results

LS-BMD was significantly higher 6 months after the initiation of bazedoxifene administration. eGFRcys had increased by 3 months after initiation and was stable until 12 months. Serum phosphate gradually decreased after initiation, reaching statistical significance at 6 months. The changes in serum phosphate were also significant when the maximum tubular reabsorption rate of phosphate was normalized to glomerular filtration rate (TmP/GFR), indicating that bazedoxifene treatment reduces serum phosphate by increasing the urinary excretion of phosphate. The change in eGFRcys after the initiation of bazedoxifene was significantly negatively correlated with the change in serum phosphate, suggesting that a reduction in serum phosphate improves renal function.

Conclusion

Bazedoxifene improves renal function, possibly by increasing renal phosphate excretion, in postmenopausal osteoporotic women without severe renal insufficiency.

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Author information

Authors and Affiliations

  1. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Hideki Masaki, Yasuo Imanishi, Yuki Nagata, Masafumi Kurajoh, Masanori Emoto & Masaaki Inaba

  2. Kousai-in Hospital, Osaka, Japan

    Hiroshi Naka

  3. Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan

    Katsuhito Mori

  4. Izumi Otsu Municipal Hospital, Osaka, Japan

    Takami Miki

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  1. Hideki Masaki
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  2. Yasuo Imanishi
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Contributions

HM contributed to the acquisition, analysis, and interpretation of the data. YI, HN, and TM contributed to the conception and design of the study. YI, HN, YN, MK, KM, ME, TM, and MI contributed to the acquisition of the data. HM takes responsibility for the integrity of the data analysis. All authors participated in drafting or revising the manuscript and approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Yasuo Imanishi.

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Conflict of interest

TM and MI has received grant support and lecture fees from Pfizer Japan Inc. YI, EM, TM, and MI have received lecture fees from Pfizer Japan Inc. HM, HN, YN, and KM have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Masaki, H., Imanishi, Y., Naka, H. et al. Bazedoxifene improves renal function and increases renal phosphate excretion in patients with postmenopausal osteoporosis. J Bone Miner Metab 38, 405–411 (2020). https://doi.org/10.1007/s00774-019-01073-1

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  • DOI: https://doi.org/10.1007/s00774-019-01073-1

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