Multidisciplinary team approach for CKD-associated osteoporosis.

Area of Science:

• Nephrology
• Endocrinology
• Rheumatology
• Bone Biology

Background:

• Chronic kidney disease-mineral and bone disorder (CKD-MBD) significantly increases cardiovascular disease and fracture risks in CKD patients.
• While diagnostic tools like bone turnover markers and imaging are available, bone biopsy remains crucial for complex CKD-associated osteoporosis cases.
• The European Renal Osteodystrophy (EUROD) initiative addresses challenges in managing CKD-MBD and osteoporosis.

Purpose of the Study:

• To introduce and evaluate the utility of a kidney-bone multidisciplinary team (MDT) for diagnosing and managing challenging CKD-associated osteoporosis.
• To demonstrate how MDT collaboration can improve diagnostic accuracy and therapeutic strategies for CKD-MBD.
• To advocate for the establishment of kidney-bone MDTs at various healthcare levels.

Main Methods:

• The European Renal Osteodystrophy (EUROD) initiative organized virtual clinical-pathological case conferences focusing on complex CKD-associated osteoporosis cases requiring bone biopsy.
• Four representative cases were selected for discussion by a kidney-bone MDT comprising a nephrologist, endocrinologist, and rheumatologist.
• The MDT provided comments on diagnostic and therapeutic decisions for each case.

Main Results:

• The selected cases represented a wide range of CKD-associated osteoporosis issues, including fractures in advanced CKD (G5D), post-transplant bone disease, impaired mineralization, low bone turnover, and severe hyperparathyroidism.
• MDT members' comments were largely complementary and added value to the existing diagnostic and therapeutic approaches.
• The collaborative MDT approach demonstrated clinical utility in managing CKD-MBD.

Conclusions:

• A kidney-bone MDT approach offers a valuable framework for improved diagnostics and tailored therapies in CKD-associated osteoporosis.
• The establishment of kidney-bone MDTs is recommended to enhance patient care for CKD-MBD at local, national, and international levels.
• This collaborative model can lead to better outcomes for patients suffering from the bone complications of chronic kidney disease.