Bone turnover markers in the management of CKD-associated osteoporosis-a European consensus

Area of Science:

• Nephrology
• Endocrinology
• Clinical Chemistry

Background:

• Bone turnover abnormalities are prevalent in chronic kidney disease (CKD), leading to bone fragility.
• The Kidney-Disease: Improving Global Outcomes (KDIGO) introduced CKD-associated osteoporosis, emphasizing bone turnover markers (BTM) for evaluation and management.
• Current guidelines lack specific treatment targets for bone turnover in CKD.

Purpose of the Study:

• To establish consensus recommendations for the utilization of BTM in managing CKD-associated osteoporosis.
• To address the need for specific treatment targets and clinical guidance regarding BTM in CKD.

Main Methods:

• A consensus meeting involving members from the European Renal Association (ERA), International Osteoporosis Foundation (IOF), European Foundation for Clinical Chemistry and Laboratory Medicine (EFLM), and European Society of Pediatric Nephrology (ESPN).
• Review and synthesis of existing knowledge on BTM in CKD-associated osteoporosis.
• Development of recommendations based on expert consensus.

Main Results:

• Bone-specific alkaline phosphatase and tartrate resistant acid phosphatase isoform 5b are identified as reliable, non-renally cleared BTM for CKD-associated osteoporosis.
• Intact N-terminal telopeptide of type I collagen is also deemed usable in CKD.
• Methodological considerations and clinical utility of BTM for risk prediction, therapeutic strategy selection, and treatment evaluation are detailed.
• Specific diagnostic ranges for bone turnover abnormalities are provided.

Conclusions:

• Consensus recommendations are provided for the use of BTM in CKD-associated osteoporosis management.
• Future research should focus on integrating BTM with other diagnostics, establishing concrete treatment targets, and developing strategies to achieve them.