[Fractures and chronic renal insufficiency]

Area of Science:

• Nephrology
• Endocrinology
• Orthopedics

Background:

• Chronic renal insufficiency (CRI) disrupts calcium and phosphorus metabolism, leading to skeletal disorders like renal osteodystrophy.
• Renal osteodystrophy encompasses heterogeneous conditions including secondary hyperparathyroidism, adynamic bone, and osteomalacia.
• Patients with CRI exhibit a higher incidence of hip fractures, a major contributor to morbidity and mortality.

Purpose of the Study:

• To highlight the challenges in assessing fracture risk in patients with chronic renal insufficiency.
• To emphasize that bone mineral density (BMD) alone is insufficient for fracture risk evaluation in CRI.
• To advocate for comprehensive fracture risk assessment including vertebral morphometry in CRI patients.

Main Methods:

• Review of existing literature on bone metabolism in chronic renal insufficiency.
• Analysis of fracture incidence and risk factors in CRI populations.
• Discussion of diagnostic limitations of bone mineral density (BMD) in CRI.

Main Results:

• Fracture risk escalates with chronic renal disease severity, particularly in advanced CRI (creatinine clearance <15-20 mL/min).
• Low BMD is a disputed predictor of fracture risk in CRI due to multifactorial bone disorder pathogenesis.
• Increased fracture risk is observed not only in dialysis patients but also in those with milder renal disease.

Conclusions:

• Bone disorders in CRI are complex and multifactorial, requiring assessment beyond BMD.
• Vertebral morphometric evaluation, alongside densitometric assessment, is crucial for accurate fracture risk stratification in CRI.
• Proactive and comprehensive fracture risk management is essential across all stages of chronic renal insufficiency.