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Chronic kidney disease and bone metabolism
Junichiro James Kazama1, Koji Matsuo, Yoshiko Iwasaki
1Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan, jjkaz@med.niigata-u.ac.jp.
Journal of Bone and Mineral Metabolism
|February 6, 2015
Summary
Chronic kidney disease-associated mineral and bone disease (CKD-MBD) involves bone fragility. Uremic osteoporosis, a distinct form, causes bone fragility due to uremia, not mineral imbalances, and resembles senile osteoporosis.
Area of Science:
- Nephrology
- Bone Metabolism
- Pathology
Background:
- Chronic kidney disease-related mineral and bone disease (CKD-MBD) is a complex systemic disorder.
- Renal osteodystrophy describes bone lesions within CKD-MBD.
- CKD presents numerous factors contributing to bone fragility and osteopenia.
Purpose of the Study:
- To introduce and define "uremic osteoporosis" as a specific condition.
- To differentiate uremic osteoporosis from CKD-MBD.
- To highlight the similarities between uremic and senile osteoporosis.
Main Methods:
- Review of existing literature on CKD-MBD and bone pathology.
- Identification of factors contributing to bone fragility in CKD.
- Clinical and pathological comparison of different osteoporosis types.
Main Results:
- Multiple factors in CKD contribute to bone fragility, including altered bone turnover, mineralization defects, sclerostin levels, apoptosis, and collagen crosslinking.
- Some bone fragility factors in CKD are independent of systemic mineral metabolism abnormalities.
- Uremic osteoporosis is proposed to describe bone fragility directly induced by uremia.
Conclusions:
- Uremic osteoporosis is a distinct entity characterized by bone fragility not solely explained by CKD-MBD mineral disturbances.
- The pathological presentation of uremic osteoporosis shares similarities with senile osteoporosis.
- Further research is needed to fully elucidate the mechanisms and clinical implications of uremic osteoporosis.
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