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Published on: June 2, 2022
Bone disease in CKD
1University of Washington, Seattle, Washington 98195-6426, USA. smott@uw.edu
Insights
Fractures are common in chronic kidney disease (CKD). Research shows adynamic bone and high FGF23 levels negatively impact bone health, necessitating caution with bone turnover inhibitors.
Area of Science:
- Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Fractures are a significant complication in chronic kidney disease (CKD).
- Previous research highlighted uncertainties in CKD-related bone and mineral disorders.
- This review focuses on bone-related findings since the 2009 KDIGO report.
Purpose of the Study:
- To review recent research on bone disease in chronic kidney disease.
- To update understanding following the 2009 KDIGO guidelines.
Main Methods:
- Literature review of studies published after the 2009 KDIGO report.
- Focus on bone-related research in CKD patients.
Main Results:
- Bone biopsies indicate a trend towards adynamic bone, potentially linked to vascular calcifications.
- Significant racial variations exist in skeletal metabolism.
- Neuromuscular tests may be more predictive of fractures than bone density.
- High fibroblast growth factor 23 (FGF23) levels show a detrimental effect on bone.
- Interactions between FGF23, parathyroid hormone, and wnt-signaling pathways are newly elucidated.
Conclusions:
- Caution is advised when using medications that inhibit bone turnover.
- Racial disparities in vitamin D therapy response require further investigation.
- Targeting wnt-signaling pathways shows therapeutic promise for bone disease.
- Future treatments depend on a deeper understanding of bone and vascular physiology in CKD.
Purpose Of Review:
Fractures are a common problem in chronic kidney disease (CKD). The 2009 KDIGO (Kidney Disease: Improving Global Outcomes) review of the bone and mineral disorders highlighted areas of uncertainty and stressed the importance of further research. This review includes studies published since that report with a focus on the bone.
Recent Findings:
Bone biopsies have shown a shift toward more adynamic bone, which may be associated with vascular calcifications. There are important racial differences in skeletal metabolism. Bone density may be helpful in identifying patients who have fractures, but neuromuscular tests perform better than radiographic ones. Even if bone density can predict fractures, it is still not clear what can be done in patients who have advanced stages of CKD. New data show interrelationships of fibroblast growth factor 23 (FGF23) secretion, parathyroid hormone, and wnt-signaling pathways. High FGF23 could have a negative impact on the bone.
Summary:
These advances suggest that caution must be used prior to treatment with medications that inhibit bone turnover. Racial differences in response to vitamin D therapy need more careful delineation. Medications which inhibit wnt-signaling offer hope but development of new therapies to treat the bone disease will rely on further understanding of bone and vascular physiology.
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