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Multidisciplinary team approach for CKD-associated osteoporosis
Ditte Hansen1,2, Hanne Skou Jørgensen3,4, Thomas Levin Andersen5,6,7,8
1Department of Nephrology, Copenhagen University Hospital - Herlev, Copenhagen, Denmark.
Insights
A multidisciplinary team (MDT) approach improves diagnosis and treatment for chronic kidney disease-mineral and bone disorder (CKD-MBD) and associated osteoporosis. This kidney-bone MDT enhances patient care for complex CKD cases.
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.
Abstract:
Chronic kidney disease-mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected four representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKD G5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.
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