Advances in renal bone disease: osteoporosis and chronic kidney disease

Osteoporosis is a common bone disease characterized by low bone density, microarchitectural deterioration of bone tissue, and a consequent increase in fracture risk. Recent decades have seen major advances in the understanding of the pathophysiology, prevention, and treatment of this disorder. Chronic kidney disease (CKD) affects more than 20 million Americans and is associated with unique metabolic mineral disorders related to low bone density and increased fractures. Because many patients with low bone density may have CKD, and the combination of osteoporosis and CKD may further increase fracture risk with increased morbidity and mortality, appropriate identification is necessary for effective management. The clinical, laboratory, and imaging studies currently used to diagnose osteoporosis in the general population inadequately detect the complex bone and metabolic changes that occur with CKD. This review focuses on the pathophysiology of osteoporosis and CKD and discusses problems with current diagnostic tools and considerations for treatment regimens.