Bone Quality in CKD Patients: Current Concepts and Future Directions – Part I

Abstract

<b><i>Background:</i></b> There is ample evidence that patients with CKD have an increased risk of osteoporotic fractures. Bone fragility is not only influenced by low bone volume and mass but also by poor microarchitecture and tissue quality. More emphasis has been given to the quantitative rather than qualitative assessment of bone health, both in general population and CKD patients. Although bone mineral density (BMD) is a very useful clinical tool in assessing bone strength, it may underestimate the fracture risk in CKD patients. Serum and urinary bone biomarkers have been found to be reflective of bone activities and predictive of fractures independently of BMD in CKD patients. Bone quality and fracture risk in CKD patients can be better assessed by utilizing new technologies such as trabecular bone score and high-resolution imaging studies. Additionally, invasive assessments such as bone histology and micro-indentation are useful counterparts in the evaluation of bone quality. <b><i>Summary:</i></b> A precise diagnosis of the underlying skeletal abnormalities in CKD patients is crucial to prevent further bone loss and fractures. We must consider bone quantity and quality abnormalities for management of CKD patients. Here in this part I, we are focusing on advances in bone quality diagnostics that are expected to help in proper understanding of the bone health in CKD patients. <b><i>Key Messages:</i></b> Assessment of bone quality and quantity in CKD patients is essential. Both noninvasive and invasive techniques for the assessment of bone quality are available.

[Retracted] Effect of New Nursing Team Management Mode on Self‐Efficacy, Compliance, and Quality of Life of Patients with Chronic Kidney Disease and Its Chain Mediating Effect

“…Most chronic renal failure (CRF) patients have psychological problems of varying degrees, resulting in a low quality of life [ 2 ]. Compliance and self-efficacy are the main factors affecting the therapeutic effect of MHD, so improving treatment compliance and self-efficacy is of great significance to reduce the negative emotions and improve the quality of life of MHD patients with chronic renal failure [ 3 ]. Team nursing is an emerging nursing intervention mode in recent years.…”

Inositol 1,4,5-trisphosphate receptor type 2 is associated with the bone–vessel axis in chronic kidney disease–mineral bone disorder

“…The PINP levels were increased and TRACP-5B levels were decreased in rats with CKD–MBD at four weeks compared to those in the sham group. Although OCN, PINP, and CTX-I are easily cleared from kidneys compared to TRACP-5B [ 41 ], their clinical association with CKD remains unclear. Therefore, the current study could consider all the above parameters suggesting dynamic characteristics of bone turnover throughout CKD–MBD.…”

Is Adynamic Bone Always a Disease? Lessons from Patients with Chronic Kidney Disease

“…In patients with CKD, DXA scan has several limitations, including confounded results due to soft-tissue calcifications and osteoarthritis. [ 128 ]. On the other hand, QCT is less confounded by these abnormalities, and moreover, it discriminates trabecular from cortical bone.…”

“…The major limitation of these diagnostic tools is the inability to identify the bone-turnover activity and the ROD type. Notably, DXA and QCT can be helpful in diagnosing asymptomatic vertebral fractures and cardiovascular calcifications that are not uncommon in patients with ADB [ 128 , 129 ]. Estimation of trabecular bone score by the DXA machine is a helpful non-invasive tool to evaluate the bone microarchitecture, which might reflect the bone quality and strength [ 128 ].…”