Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment.

Kidney International
Mathias HaarhausChronic Kidney Disease Mineral and Bone Disorder (CKD-MBD) working group of the European Renal Association–European Dialysis

Abstract

Patients with chronic kidney disease (CKD) have an increased fracture risk because of impaired bone quality and quantity. Low bone mineral density predicts fracture risk in all CKD stages, including advanced CKD (CKD G4-5D). Pharmacological therapy improves bone mineral density and reduces fracture risk in moderate CKD. Its efficacy in advanced CKD remains to be determined, although pilot studies suggest a positive effect on bone mineral density. Currently, antiresorptive agents are the most commonly prescribed drugs for the prevention and therapy of osteoporosis. Their use in advanced CKD has been limited by the lack of large clinical trials and fear of causing kidney dysfunction and adynamic bone disease. In recent decades, adynamic bone disease has evolved as the most predominant form of renal osteodystrophy, commonly associated with poor outcomes, including premature mortality and progression of vascular calcification. Evolving evidence indicates that reduction of bone turnover by parathyroidectomy or pharmacological therapies, such as calcimimetics and antiresorptive agents, are not associated with premature mortality or accelerated vascular calcification in CKD. In contrast, chronic inflammation, oxidative stress, malnutr...Continue Reading

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Citations

Aug 24, 2021·Kidney International·Susan M OttGrahame J Elder
Sep 8, 2021·Journal of Cellular and Molecular Medicine·Weichun ChenXiao Chang

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