Abstract
Bone disease and fractures are common in patients with chronic kidney disease (CKD). The etiology of bone disease in CKD is complex due to a combination of osteoporosis and/or CKD-mineral and bone disorder (CKD-MBD). Identifying the type of bone disease is important as treatments for osteoporosis may differ from CKD-MBD. In predialysis CKD, bone mineral density by dual energy x-ray absorptiometry may be useful in identifying those at high risk of fracture. The ability of noninvasive imaging to diagnose/predict fracture risk in later stages of CKD is unclear. Pharmacologic treatments approved for postmenopausal osteoporosis may be appropriate, in the absence of abnormal mineral metabolism, for use for a limited time in stages 1–3 CKD; however, use in stages 4–5D CKD would be off label. Further studies are needed.
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