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A consensus statement on the management of vertebral fractures in CKD stages G4-G5D

Maria Fusaro1,2, Manju Chandran3, Thomas Nickolas4

  • 1National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|November 28, 2025
PubMed

Insights

Patients with chronic kidney disease (CKD) have a higher risk of fractures. This paper focuses on managing skeletal fragility and vertebral fractures in advanced CKD patients, highlighting diagnosis and treatment strategies.

Area of Science:

  • Nephrology
  • Orthopedics
  • Cardiovascular Medicine

Background:

  • Skeletal fragility is underrecognized in chronic kidney disease (CKD).
  • CKD patients have double the risk of hip fracture.
  • Vertebral fractures in advanced CKD are linked to vascular calcifications and cardiovascular events.

Purpose of the Study:

  • To comprehensively discuss the management of skeletal fragility in CKD patients.
  • To increase awareness of CKD-associated osteoporosis.
  • To focus on diagnosis and treatment of vertebral fractures in CKD G4-G5D.

Main Methods:

  • Consensus paper development.
  • Review of current literature on skeletal fragility in CKD.
  • Focus on diagnostic and therapeutic strategies for vertebral fractures.

Main Results:

  • Skeletal fragility, particularly vertebral fractures, poses a significant risk in CKD.
  • Advanced CKD (G4-G5D) shows strong associations between vertebral fractures, vascular calcifications, and cardiovascular events.
  • The term CKD-associated osteoporosis aims to improve clinical awareness.

Conclusions:

  • Effective management strategies for skeletal fragility are crucial in CKD patients.
  • Early diagnosis and targeted treatment of vertebral fractures are essential, especially in advanced CKD.
  • Addressing skeletal fragility in CKD can potentially reduce fracture risk and cardiovascular complications.

Keywords:
CKD-MBDbone mineral densitychronic renal insufficiencyskeletal fragilityvertebral fractures

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