Bone kidney interactions.

Area of Science:

• Nephrology
• Orthopedics
• Endocrinology

Background:

• Bone and kidney disease frequently coexist, a condition termed chronic kidney disease mineral bone disorder (CKD-MBD).
• Historically, bone was considered a passive victim of CKD-MBD, developing secondary to disordered mineral metabolism caused by kidney disease.
• Emerging evidence suggests a more complex interplay, with bone potentially playing an active role in the pathogenesis of CKD-MBD.

Purpose of the Study:

• To review the epidemiology of fractures in patients with chronic kidney disease (CKD).
• To discuss the utility of imaging and mineral metabolism markers in assessing fracture risk within CKD.
• To explore the evolving understanding of bone's active role in CKD-MBD, including its early onset and influence on other organ systems.

Main Methods:

• Review of epidemiological data on fractures in CKD patients.
• Analysis of the role of imaging modalities in fracture risk assessment.
• Evaluation of mineral metabolism markers for predicting fracture risk.
• Synthesis of recent research on the pathophysiology of CKD-MBD, focusing on bone's signaling pathways.

Main Results:

• Fractures are a significant concern in the CKD population.
• Imaging and biochemical markers provide valuable insights into fracture risk.
• Evidence indicates CKD-MBD develops early in CKD progression.
• Bone actively participates in CKD-MBD through novel molecular secretions and signaling pathways, influencing systemic health.

Conclusions:

• CKD-MBD is an early complication of CKD, not merely a consequence of long-term kidney dysfunction.
• Bone is an active endocrine organ that influences systemic metabolism and disease progression in CKD.
• A paradigm shift is needed to view CKD-MBD as a dynamic interaction between bone and kidney, impacting multiple organ systems.