Bone Quality in Chronic Kidney Disease Patients: Current Concepts and Future Directions – Part II

Abstract

<b><i>Background:</i></b> Patients with chronic kidney disease (CKD) have an increased risk of osteoporotic fractures, which is due not only to low bone volume and mass but also poor microarchitecture and tissue quality. The pharmacological and nonpharmacological interventions detailed, herein, are potential approaches to improve bone health in CKD patients. Various medications build up bone mass but also affect bone tissue quality. Antiresorptive therapies strikingly reduce bone turnover; however, they can impair bone mineralization and negatively affect the ability to repair bone microdamage and cause an increase in bone brittleness. On the other hand, some osteoporosis therapies may cause a redistribution of bone structure that may improve bone strength without noticeable effect on BMD. This may explain why some drugs can affect fracture risk disproportionately to changes in BMD. <b><i>Summary:</i></b> An accurate detection of the underlying bone abnormalities in CKD patients, including bone quantity and quality abnormalities, helps in institution of appropriate management strategies. Here in this part II, we are focusing on advancements in bone therapeutics that are anticipated to improve bone health and decrease mortality in CKD patients. <b><i>Key Messages:</i></b> Therapeutic interventions to improve bone health can potentially advance life span. Emphasis should be given to the impact of various therapeutic interventions on bone quality.

Chest CT radiomics is feasible in evaluating bone changes in chronic kidney diseases

“…Renal osteodystrophy (ROD) is frequently seen at the end stage of renal diseases (4). The decrease in density and strength of bone increased the risk of fracture for patients with CKD (5,6). Local bone destruction (called fibrous osteoarthritis) can be observed in some cases of CKD using computed tomography (CT) or X-ray, while osteoporosis is more frequently seen (7).…”

Chronic kidney disease to osteoporosis: histopathological analysis on animal model with unilateral ureteral obstruction method

“…The increased bone remodeling process, where the rate of bone resorption exceeds the rate of bone formation, will result in clinical conditions of osteopenia, which can progressively lead to osteoporosis (Hruska et al, 2017). Disturbances in the quantity and quality of bone lead to an increased risk of fracture in patients with CKD, which increases with CKD-stage progression (McNerny and Nickolas, 2017;Evenepoel et al, 2019;Asadipooya et al, 2021). The risk of fracture of the femur is known to be high in patients on hemodialysis in various countries, where the risk is increased four to 13 times compared with the general population (Kazama, 2017).…”