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Fracture risk assessment in patients with chronic kidney disease

S A Jamal1, S L West, P D Miller

  • 1Department of Medicine, University of Toronto, Toronto, ON, Canada. sophie.jamal@utoronto.ca

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|September 9, 2011
PubMed

Insights

Fractures are common in chronic kidney disease (CKD) patients, especially those on hemodialysis. Current bone density tests are limited for predicting fractures in CKD, necessitating new assessment methods.

Area of Science:

  • Nephrology
  • Orthopedics
  • Metabolic Bone Disease

Background:

  • Patients with chronic kidney disease (CKD) experience high rates of fractures, leading to significant morbidity and mortality.
  • Bone mass measurements are standard for fracture risk in the general population, but their effectiveness in CKD patients, particularly those on hemodialysis, remains uncertain.

Purpose of the Study:

  • To review the epidemiology and causes of fractures in CKD patients, focusing on hemodialysis.
  • To summarize existing data on fracture risk factors, including bone mass, mineral metabolism markers, and muscle strength, in CKD.
  • To highlight the limitations of current bone density testing in CKD.

Main Methods:

  • Literature review of studies on fractures in CKD patients.
  • Analysis of data linking risk factors (bone mass, biochemical markers, muscle strength) to fractures.
  • Evaluation of dual energy X-ray absorptiometry (DXA) and peripheral quantitative tomography (pQCT) utility in CKD.

Main Results:

  • CKD patients fracture due to poor bone quantity, quality, and neuromuscular function.
  • Evidence linking bone quality, turnover markers, and neuromuscular function to fractures in CKD is scarce.
  • Bone mineral density testing has limited clinical utility for fracture prediction in CKD, especially in advanced stages (4 and 5).

Conclusions:

  • Fractures in CKD are multifactorial, involving bone and muscle impairments.
  • Current bone density measurements are inadequate for reliable fracture risk assessment in CKD patients.
  • Further research is needed to develop noninvasive measures of bone strength for improved fracture risk prediction in CKD.

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