Abstract
Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD.
Highlights
Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures
The Longitudinal Aging Study Amsterdam (LASA) survey found that early decreased renal function was related to increase incident fracture risk, but not with increased prevalence of vertebral fracture or falls [10]
This review focuses on the evaluation and management of patients with Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)
Summary
Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. For patients with CKD stage G3a and G3b, the GFRs decrease from mild to moderate (40–59 mL/min/1.73 m2) and moderate to severe (30–44 mL/min/1.73 m2). The renal function is severely impaired in patients with CKD stage 4 (15–29 mL/min/1.73 m2), and CKD stage 5 (add D if treated by dialysis) referring to kidney failure (less than 15 mL/min/1.73 m2) [1]. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality [3]. Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture [4]. The consequence of fractures increased the mortality rate in CKD patients with non-dialysis [9] and with dialysis [12]. This review focuses on the evaluation and management of patients with CKD-MBD
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