[Secondary osteoporosis UPDATE. Bone disease with decreased kidney function]

Area of Science:

• Nephrology
• Endocrinology
• Bone Metabolism

Context:

• Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a significant systemic complication associated with increased fracture risk, cardiovascular disease, and mortality.
• Understanding the underlying pathophysiology of CKD-MBD is vital for early therapeutic intervention to prevent or mitigate complications, especially in advanced stages of kidney disease.
• Current guidelines recommend managing osteoporosis and fracture risk in early CKD stages similarly to the general population.

Purpose:

• To highlight the importance of defining the pathophysiologic processes underlying CKD-MBD for timely therapeutic intervention.
• To underscore the current gap in knowledge regarding the optimal treatment strategies for fragility fractures in patients with later stages of chronic kidney disease.

Summary:

• CKD-MBD is a systemic disorder linked to adverse outcomes including fractures, cardiovascular events, and mortality.
• Early intervention in CKD-MBD can prevent or reduce the severity of bone abnormalities.
• While management for early CKD stages aligns with general osteoporosis guidelines, data on treating fragility fractures in advanced CKD is limited.

Impact:

• Emphasizes the need for further research into effective treatments for fragility fractures in advanced CKD patients.
• Highlights the clinical significance of CKD-MBD as a predictor of poor outcomes.
• Stresses the importance of early diagnosis and management of CKD-MBD to improve patient prognosis.