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Background: Osteoporosis increases morbidity and mortality in patients on chronic hemodialysis. There are some preliminary studies that demonstrated the safety and the efficacy of bisphosphonate group, especially alendronate in treating osteoporosis in patients with chronic kidney failure. Objectives: To determine the efficacy and the safety of alendronate combined with cholecalciferol in osteoporosis treatment in patients on chronic hemodialysis. Methods: We conducted a non-controlled interventional trial. All chronically hemodialytic patients diagnosed with osteoporosis at one or more regions of interest: neck, trochanter, intertrochanter, Ward triangle and total neck were given 70 mg alendronate combined with 2800 IU cholecalciferol once a week. They were indicated bone density measure by dual energy absorptiometry 3 times: at the beginning, 3 months and 6 months after treatment initiation. Primary outcome was improvement in bone density and prevalence of osteoporosis. Results: We included 32 patients in this trial. The prevalence of osteoporosis at the neck, trochanter, intertrochanter, Ward triangle and total neck were 93.8%; 31.3%; 56.3%; 81.3% and 68.8% respectively. The bone density trended to improve after 3 months and 6 months, although not significantly. The prevalence of osteoporosis showed a decrease from 100% to 90.6% after 6 months, but this change was not statistically significant. Duodenal gastric symptoms appeared in 4 patients, but all of them were well controlled with proton pump inhibitors. Conclusion: Alendronate combined with cholecalciferol showed efficacy and safety in the treatment of osteoporosis in hemodialytic patients. The preliminary results showed a non-significant improvement of the bone density and of the osteoporosis prevalence. Perhaps it requires another longer and larger trial to visualize these improvements

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