Bone biopsy in chronic kidney disease: still an option?

Drueke, Tilman B.

doi:10.1590/2175-8239-jbn-2020-0035

Cited by 3 publications

(2 citation statements)

References 7 publications

(9 reference statements)

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“…One study that based bisphosphonate, cinacalcet or teriparatide treatment on bone biopsy results reported improved BMD in patients treated with teriparatide, but not in the other groups, after an average treatment period of 13–16 months [ 27 ]. Thus, we have no current evidence that bone biopsy findings predict outcomes, the relationship between the types of ROD and fractures remain uncertain [ 28 ]. It can be argued that the variables derived from histomorphometry such as bone formation or mineralisation rates may not be the prime determining factors of fracture risk in CKD.…”

Section: Assessment Of Bone Health In Ckd and Esrdmentioning

confidence: 99%

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

et al. 2021

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This article aims to review the methods used for the assessment of fracture risk and the use of osteoporosis medications for fracture prevention in the population with CKD, and highlights the difficulties faced by clinicians in the management of these patients and the latest recommendations and guidelines. Chronic kidney disease (CKD) and osteoporosis often co-exist in older adults, and they present a major healthcare challenge. CKD mineral and bone disorder (CKD-MBD) occurs as renal function declines and this syndrome affects most patients in CKD stages 4 and 5. The biochemical abnormalities of CKD-MBD, renal bone disease and risk factors associated with age-related bone loss and osteoporosis lead to a cumulative effect on fracture risk and mortality. There is a need for routine evaluation of fracture risk and fracture prevention in this population. Measurement of bone mineral density (BMD) and the use of the FRAX tool have predictive value for incident fractures in the general population and in CKD. This enables physicians to identify CKD patients most at risk of sustaining a fragility fracture and allows a more targeted approach to fracture prevention. Data analysis from the pivotal trials of therapeutic agents used in osteoporosis show that these drugs can be considered in mild and moderate CKD (stages 1–3 CKD). Off-label drug use in patients with CKD-MBD and more severe renal impairment (CKD stages 4 and 5) could offer significant benefits to sub-groups of patients when carefully tailored to each individual’s bone turnover and calcium and phosphate balance. However, this requires a selective approach and treatment decisions based on inference from pathophysiology while we await further trials. Guidelines advocate the correction and/or reduction of the biochemical abnormalities of CKD-MBD before initiation of treatment with osteoporosis drugs and close monitoring during treatment.

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Section: Assessment Of Bone Health In Ckd and Esrdmentioning

confidence: 99%

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

et al. 2021

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“…However, this procedure is too complicated to be widely applied in clinical practice. Additionally, 50-80% of the CKD population have comorbid bone disorders, meaning this approach could not be applied to most CKD patients [88][89][90]. Thus, optimizing current indicators or testing multiple potential indicators of phosphorus overload may be a good future direction.…”

Section: Early Markers Of Phosphorus Overloadmentioning

confidence: 99%

Focusing on Phosphorus Loads: From Healthy People to Chronic Kidney Disease

et al. 2023

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Phosphorus is an essential micromineral with a key role in cellular metabolism and tissue structure. Serum phosphorus is maintained in a homeostatic range by the intestines, bones, and kidneys. This process is coordinated by the endocrine system through the highly integrated actions of several hormones, including FGF23, PTH, Klotho, and 1,25D. The excretion kinetics of the kidney after diet phosphorus load or the serum phosphorus kinetics during hemodialysis support that there is a “pool” for temporary phosphorus storage, leading to the maintenance of stable serum phosphorus levels. Phosphorus overload refers to a state where the phosphorus load is higher than is physiologically necessary. It can be caused by a persistently high-phosphorus diet, renal function decline, bone disease, insufficient dialysis, and inappropriate medications, and includes but is not limited to hyperphosphatemia. Serum phosphorus is still the most commonly used indicator of phosphorus overload. Trending phosphorus levels to see if they are chronically elevated is recommended instead of a single test when judging phosphorus overload. Future studies are needed to validate the prognostic role of a new marker or markers of phosphorus overload.

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Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D

Мазуренко

Nakatis

Mazurenko³

et al. 2023

Nefrologiâ (St.-Peterbg.)

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BACKGROUND. Chronic kidney disease leads to increased bone fragility and fractures. Assessing the risk of fractures is a direct way to prevent them. THE AIM: to assess the possibility of using DXA to predict fracture risk in patients with stage 5D CKD. PATIENTS AND METHODS. The prospective cohort study included 359 patients (166 men, 193 women). BMD was evaluated by DRA. Some markers of mineral and bone metabolism were also analyzed. All fractures in patients were recorded from the moment of inclusion in the study. RESULTS. All patients with fractures had lower BMD and received longer-term renal replacement therapy (RRT). The absolute risk of fractures increased as BMD decreased. Patients with fractures had higher levels of parathyroid hormone and alkaline phosphatase. Stepwise multivariate regression analysis showed that the combination of BMD scores of the forearm, hip, lumbar vertebrae and the duration of RRT best predicts the risk of fractures. The presence of previous fractures also increases risk for the future. Risk of fractures in man and women did not differ. CONCLUSION. The risk of fractures in patients with CKD 5 st. on maintenance hemodialysis increases with a decrease in BMD, an increase in the duration of RRT and the presence of previous fractures, but does not significantly depends on the gender of the patients. It is also can be concluded that it is possible to use criteria reflecting the state of BMD, taking into account their sensitivity and specificity, in assessing the risk of fractures in patients with CKD 5D st.

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Bone biopsy in chronic kidney disease: still an option?

Abstract: Bone biopsy in chronic kidney disease: still an option? Biópsia óssea na doença renal crônica: ainda é uma opção?

Cited by 3 publications

References 7 publications

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

Focusing on Phosphorus Loads: From Healthy People to Chronic Kidney Disease

Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D

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