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Abstract
Although frequently silent, mineral and bone disease (MBD) is one of the most precocious complication of chronic kidney disease (CKD) and is omnipresent in patients with CKD stage 5. Its pathophysiology is complex, but basically, disturbances in vitamin D, phosphate, and calcium metabolism lead to a diverse range of clinical manifestations with secondary hyperparathyroidism usually being the most frequent. With the decline in renal function, CKD-MBD may induce microstructural changes in bone, vascular system and soft tissues, which results in macrostructural lesions, such as low bone mineral density (BMD) resulting in skeletal fractures, vascular and soft tissue calcifications. Moreover, low BMD, fractures, and vascular calcifications are linked with increased risk of cardiovascular mortality and all-cause mortality. Therefore, a better characterization of CKD-MBD patterns, beyond biochemical markers, is helpful to adapt therapies and monitor strategies as used in the general population. An in-depth characterization of bone health is required, which includes an evaluation of cortical and trabecular bone structure and density and the degree of bone remodeling through bone biomarkers. Standard radiological imaging is generally used for the diagnosis of fracture or pseudo-fractures, vascular calcifications and other features of CKD-MBD. However, bone fractures can also be diagnosed using computed tomography (CT) scan, magnetic resonance (MR) imaging and vertebral fracture assessment (VFA). Fracture risk can be predicted by bone densitometry using dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QTC) and peripheral quantitative computed tomography (pQTC), quantitative ultrasound (QUS) and most recently magnetic resonance micro-imaging. Quantitative methods to assess bone consistency and strength complete the study and adjust the clinical management when integrated with clinical factors. The aim of this review is to provide a brief and comprehensive update of imaging techniques available for the diagnosis, prevention, treatment and monitoring of CKD-MBD.
Highlights
Introduction and PathophysiologyThe mineral and bone disorders associated with chronic kidney disease (CKD) are often progressive in earlier stages of CKD but remain clinically silent until stages G3b-G4 (estimated glomerular filtration rate 30 to 44 or 15 to 29 mL/min/1.73 m2 of body surface)
Serum bone biomarkers are the earliest indicators of mineral bone diseases (MBD) during CKD progression, starting with decreased circulating alpha klotho levels and an increase of serum fibroblast growth factor 23 (FGF23)
The aim of this review is to provide a brief and comprehensive update of the imaging modalities available for the diagnosis, prevention, treatment and monitoring of CKD-MBD/osteoporosis complex in CKD patients
Summary
The mineral and bone disorders associated with chronic kidney disease (CKD) are often progressive in earlier stages of CKD but remain clinically silent until stages G3b-G4 (estimated glomerular filtration rate (eGFR) 30 to 44 or 15 to 29 mL/min/1.73 m2 of body surface). Seen more globally, bone disease in CKD is the sum of CKD-specific risk factors, which are in turn dependent on CKD progression, together with age- or sex-related bone loss These complex and interacting changes to bone require careful evaluation, including using imaging techniques [3]. In CKD stages 1 and 2 (eGFR >60 mL/min/1.73 m2), risk factors for bone fracture are the same as in the general population and include a history of previous fracture, female gender, older age, lower body mass index (BMI) and the use of corticosteroids (Figure 1). As CKD advances, osteoporosis prevalence increases [4] due to age-related bone loss in addition to the CKD-MBD related bone disease (Figure 1), until ‘osteoporosis’ affects the majority of patients with CKD stage 5 [5]. The aim of this review is to provide a brief and comprehensive update of the imaging modalities available for the diagnosis, prevention, treatment and monitoring of CKD-MBD/osteoporosis complex in CKD patients
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