The CKD-OSTEO Score: A Chronic Kidney Disease-specific Tool for Osteoporosis Risk Stratification

Osteoporosis in patients with chronic kidney disease (CKD) frequently goes undiagnosed and is not treated adequately, largely due to its intricate pathophysiology and the lack of risk stratification tools specific to CKD. Standard tools used for the general populace, such as the Fracture Risk Assessment Tool (FRAX) score and bone mineral density-based thresholds, fail to accurately represent the unique biochemical and structural bone alterations that take place in CKD stages IIIb-VD. We propose the Chronic Kidney Disease Osteoporosis Stratification Tool for Evaluation and Optimization (CKD-OSTEO) score, an innovative multidimensional clinical tool intended to evaluate the risk of osteoporosis, direct diagnostic assessments and inform suitable treatment strategies for patients with CKD. This score integrates conventional fracture risk factors with CKD-specific components, such as dialysis vintage, intact parathormone levels, serum Klotho levels and T-scores. We explain the pathophysiological rationale for each element, categorize patients into various management levels and provide customized recommendations for starting and selecting anti-resorptive therapy. Emphasis is placed on the growing importance of Klotho deficiency as a marker of bone-vascular ageing. With this article, we advocate for the regular risk stratification of patients with CKD to enhance fracture prevention, tailor treatment strategies and incorporate new biomarkers like Klotho into practice.