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Evaluating bone quality in patients with chronic kidney disease
Hartmut H Malluche1, Daniel S Porter, David Pienkowski
1Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Albert B. Chandler Medical Center, 800 Rose Street, Room MN-564, Lexington, KY 40536-0298, USA.
Nature Reviews. Nephrology
|October 9, 2013
Summary
Chronic kidney disease-mineral and bone disorder (CKD-MBD) impairs bone quality, increasing fracture risk. Evaluating bone from macro to nanoscale is crucial for understanding and treating CKD-MBD bone abnormalities.
Area of Science:
- Nephrology
- Orthopedics
- Biomaterials Science
Background:
- Normal bone quality and quantity withstand mechanical loads.
- Chronic kidney disease-mineral and bone disorder (CKD-MBD) negatively impacts bone quality (turnover, mineralization) and quantity (volume).
- Altered bone quality in CKD-MBD, including material, structure, and microdamage, elevates fracture rates.
Purpose of the Study:
- To highlight the importance of assessing bone quality in CKD-MBD.
- To emphasize evaluating bone across hierarchical levels, from macro-organ to nanoscale.
- To understand CKD-MBD-related bone abnormalities.
Main Methods:
- Review of current understanding of CKD-MBD effects on bone.
- Analysis of bone quality assessment techniques across multiple scales.
- Exploration of relationships between material, structure, microdamage, and mechanical properties.
Main Results:
- Fractures in CKD-MBD are not solely due to reduced bone quantity.
- Bone quality assessment requires diverse techniques, from macro- to nanoscale.
- CKD-MBD affects bone material, structure, and microdamage, impacting mechanical properties.
Conclusions:
- Comprehensive evaluation of bone quality is essential for understanding CKD-MBD.
- Understanding multi-level bone alterations can guide new therapeutic strategies.
- Targeting material, structural, and microdamage aspects may prevent/treat CKD-MBD bone disease.
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