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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Maintenance dialysis patients have a higher risk of osteoporosis than those with normal kidney function. Managing these patients with osteoporosis medications poses challenges due to the risk of hypocalcemia, given the complexity of CKD mineral and bone disorder. We aimed to examine the trajectory of serum calcium concentration and identify factors associated with developing hypocalcemia following osteoporosis medication initiation in maintenance dialysis patients.
Using the JMDC hospital database, we identified patients undergoing maintenance dialysis for >3 months. New users of osteoporosis medications were defined as patients with claims records for bisphosphonates, denosumab, romosozumab, or parathyroid hormone (PTH) analogs, with a 6-month lookback period to ensure new use. The index date was set as the first prescription date. We examined serum calcium trajectories 90 days before and after medication initiation using restricted cubic splines with mixed-effects models. Factors associated with hypocalcemia (corrected serum calcium <8.4 mg/dL) within 90 days post-initiation were analyzed using logistic regression models with multiple imputations for missing baseline variables. We also assessed the association between osteoporosis medication use and heart failure events.
Among 413 eligible maintenance dialysis patients (average age 73 years, 49% male), 263 (63.7%) received bisphosphonates, 123 (29.8%) received denosumab, 15 (3.6%) received romosozumab, and 12 (2.9%) received PTH analogs. Hypocalcemia was observed in 40.3%, 66.7%, 73.3%, and 0%, respectively. Trajectory analysis showed persistently low serum calcium levels 30-60 days after denosumab or romosozumab administration. Compared with bisphosphonates, the adjusted odds ratios for hypocalcemia were 5.75 (95% confidence interval [CI]: 3.36–9.85) for denosumab and 10.8 (95% CI: 2.70–43.1) for romosozumab. Pre-treatment hypocalcemia, hyperparathyroidism, and lack of active vitamin D use were independent risk factors for post-treatment hypocalcemia, with especially high predicted probabilities in patients with elevated PTH levels receiving denosumab or bisphosphonates. No significant link was found between osteoporosis medication use and heart failure events.
Maintenance dialysis patients receiving denosumab or romosozumab experienced significantly higher rates and longer duration of hypocalcemia compared to bisphosphonates. Pre-existing hyperparathyroidism emerged as a key risk factor, suggesting that PTH management should be optimized before initiating these medications. Enhanced calcium monitoring is essential when prescribing these agents to dialysis patients.
