Bone fragility in patients with chronic kidney disease

Area of Science:

• Nephrology
• Endocrinology
• Orthopedics

Background:

• Mineral and bone diseases (MBD) are common in chronic kidney disease (CKD) patients.
• CKD-MBD contributes to bone pain, fractures, and increased mortality.
• Current management of fractures in CKD-MBD is often suboptimal due to a lack of clear targets.

Purpose of the Study:

• To review the epidemiology and pathophysiology of CKD-MBD.
• To highlight the role of mineral and biochemical factors in CKD-MBD and fracture risk.
• To propose an algorithm for managing bone diseases and guiding treatment decisions in CKD-MBD.

Main Methods:

• Literature review focusing on epidemiology, pathophysiology, and risk factors of CKD-MBD and fractures.
• Analysis of traditional clinical risk factors, CKD-related factors, biomarkers, and imaging techniques.
• Development of a management algorithm for CKD-MBD and fracture prevention.

Main Results:

• Fracture risk is elevated in CKD-MBD due to cumulative risk factors.
• Optimal parathyroid hormone (PTH) control improves bone remodeling.
• Biomarkers (e.g., bone-specific alkaline phosphatase, CTX-I) and imaging (DEXA, QCT) aid in risk assessment.

Conclusions:

• Effective management of CKD-MBD requires a multidisciplinary approach.
• Integrated use of biomarkers and imaging can improve fracture risk evaluation.
• A proposed algorithm can guide treatment decisions for better fracture prevention in CKD-MBD patients.