Abstract
Prevention of bone fractures is one goal of therapy for patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), as indicated by the Kidney Disease: Improving Global Outcomes guidelines. CKD patients, including those on hemodialysis, are at higher risk for fractures and fracture-related death compared to people with normal kidney function. However, few clinicians focus on this issue as it is very difficult to estimate bone fragility. Additionally, uremia-related bone fragility has a more complicated pathological process compared to osteoporosis. There are many uremia-associated factors that contribute to bone fragility, including severe secondary hyperparathyroidism, skeletal resistance to parathyroid hormone, and bone mineralization disorders. Uremia also aggravates bone volume loss, disarranges microarchitecture, and increases the deterioration of material properties of bone through abnormal bone cells or excess oxidative stress. In this review, we outline the prevalence of fractures, the interaction of CKD-MBD with osteoporosis in CKD patients, and discuss possible factors that exacerbate the mechanical properties of bone.
Highlights
People are susceptible to diseases such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease
We describe the current status of fragility fractures and their treatments in chronic kidney disease (CKD) patients
Determining the pathogenesis of osteoporosis and treatment efficacy is difficult in CKD patients because of the complicated mineral and bone abnormalities in these patients
Summary
People are susceptible to diseases such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. In particular, have an approximately fourfold greater risk for hip fractures than sex- and age-matched individuals in the general population [1, 2]. Their fracture risk correlates positively with age, duration of dialysis, high or low parathyroid hormone (PTH) level, female gender, low body mass index, and presence of peripheral vascular calcification. A tool called FRAX5 that can predict fracture risk appears to be useful for predicting death among Japanese hemodialysis patients [14] Even though it remains unclear why FRAX was useful to predict mortality in Japanese dialysis patients, elucidation of the pathogenesis of decreased bone strength and treatment of fractures in patients with CKD are important to improve survival and the quality of life in this patient population. We describe the current status of fragility fractures and their treatments in CKD patients
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