Bone disease in CKD: a focus on osteoporosis diagnosis and management

Osteoporosis is defined as a condition of impairment in bone strength due to low bone mineral density and poor bone quality and predisposes individuals to an increased risk of fractures. Osteoporosis may coexist with chronic kidney disease-mineral and bone disorder (CKD-MBD) and osteoporotic fractures occur in all stages of CKD. Management of osteoporosis in CKD should consider the pathophysiology of both disorders. Diagnosis and management of osteoporosis in patients with stages 1-3 CKD and patients without CKD are similar, but diagnosis and management decisions differ greatly once patients have stages 4-5 CKD. Discriminating between osteoporosis and CKD-MBD is best accomplished with quantitative bone histomorphometry. Biochemical markers, especially intact parathyroid hormone and bone-specific alkaline phosphatase, also may be helpful. When the diagnosis of osteoporosis is established, management in stages 4-5 CKD may include antiresorptive or anabolic agents, though evidence for efficacy is marginal in advanced CKD.