Management of osteoporosis in patients with chronic kidney disease

Abdalbary, Mohamed; Sobh, Mahmoud; Elnagar, Sherouk; Elhadedy, Muhammed Ahmed; Elshabrawy, Nehal; Abdelsalam, Mostafa; Asadipooya, Kamyar; Sabry, Alaa; Halawa, Ahmed; El‐Husseini, Amr

doi:10.1007/s00198-022-06462-3

Cited by 28 publications

(31 citation statements)

References 159 publications

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“…The associations shown in Table 2 between BMD, intended as a quantitative measure of bone strength, and the qualitative indices such as TBS, and also QUS and PEUS, support this hypothesis. These findings also suggest an overall (qualitative/quantitative) bone impairment in hemodialysis patients ( 34 ).…”

Section: Discussionmentioning

confidence: 70%

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Catalano¹,

Gaudio²,

Bellone³

et al. 2022

Front. Endocrinol.

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There is growing interest in the relationship between chronic kidney disease (CKD) and fragility fracture risk. Bone mineral density (BMD) is a major determinant of bone strength, although its role as a predictor of fracture in advanced CKD and hemodialysis is still under debate. We aimed to further investigate surrogates of bone quality and their associations with muscle strength and fracture risk in hemodialysis. Multiple clinical risk factors for fracture and an estimated 10-year probability of fracture, BMD at lumbar spine and femur, trabecular bone score (TBS), X-ray vertebral morphometry, phalangeal bone quantitative ultrasonography (QUS), tibial pulse-echo ultrasonography (PEUS), and handgrip strength were evaluated in a setting of hemodialysis patients in treatment with acetate-free biofiltration (AFB) or bicarbonate hemodialysis. The bone ultrasound measurements, both at phalangeal and tibial sites, were significantly associated with lumbar and femoral DXA values. Handgrip strength was significantly associated with the 10-year probability of fracture (r = −0.57, p < 0.001 for major fractures and r = −0.53, p < 0.001 for hip fracture, respectively), with femur neck, total femur, and L1–L4 BMD values (r = 0.47, p = 0.04; r = 0.48, p = 0.02; r = 0.58, p = 0.007, respectively), with TBS at the lumbar spine (r = 0.71, p < 0.001) and with the phalangeal QUS measure of AD-SoS (r = 0.369, p = 0.023). In the hemodialysis group, 10 participants (24.3%) reported at least one morphometric vertebral fracture (Vfx); conversely, only six participants (15%) showed Vfx in the control group. In the hemodialysis group, participants with Vfx compared with participants without Vfx reported significantly different TBS, bone transmission time (BTT), cortical thickness, and handgrip strength (p < 0.05). At multiple regression analysis, by identifying as dependent variable the 10-year fracture risk for major fracture, after correcting for age, BMI, time since dialysis, AD-SoS, cortical bone thickness, and handgrip strength, only BTT (β = −15.21, SE = 5.91, p = 0.02) and TBS (β = −54.69, SE = 21.88, p = 0.02) turned out as independently associated with fracture risk. In conclusion, hemodialysis patients showed a higher fracture risk and lower surrogate indices of bone strength as TBS and QUS parameters. In this cohort of patients, handgrip strength measurements appeared to be a useful instrument to identify high-fracture-risk subjects.

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Section: Discussionmentioning

confidence: 70%

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Catalano¹,

Gaudio²,

Bellone³

et al. 2022

Front. Endocrinol.

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“…Osteoporosis or osteopenia is another common complication of CKD. The prevalence of osteoporosis in CKD patients ranged from 18% to 32%, while osteopenia was found in up to 57% of patients [ 58 , 59 ]. A significantly higher prevalence of osteoporosis and fractures has been reported in patients with end-stage renal disease (ESKD), especially in patients on hemodialysis compared to those on peritoneal dialysis [ 60 ].…”

Section: Iron Deficiency and Bone Lossmentioning

confidence: 99%

Iron Deficiency and Iron Deficiency Anemia: Potential Risk Factors in Bone Loss

Yang

Feng

et al. 2023

IJMS

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Iron is one of the essential mineral elements for the human body and this nutrient deficiency is a worldwide public health problem. Iron is essential in oxygen transport, participates in many enzyme systems in the body, and is an important trace element in maintaining basic cellular life activities. Iron also plays an important role in collagen synthesis and vitamin D metabolism. Therefore, decrease in intracellular iron can lead to disturbance in the activity and function of osteoblasts and osteoclasts, resulting in imbalance in bone homeostasis and ultimately bone loss. Indeed, iron deficiency, with or without anemia, leads to osteopenia or osteoporosis, which has been revealed by numerous clinical observations and animal studies. This review presents current knowledge on iron metabolism under iron deficiency states and the diagnosis and prevention of iron deficiency and iron deficiency anemia (IDA). With emphasis, studies related to iron deficiency and bone loss are discussed, and the potential mechanisms of iron deficiency leading to bone loss are analyzed. Finally, several measures to promote complete recovery and prevention of iron deficiency are listed to improve quality of life, including bone health.

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“…The trabecular bone score (TBS) is a DEXA-derived algorithm for the evaluation of bone microarchitecture whose utility in patient with osteoporosis has been largely demonstrated [ 48 , 114 , 115 ]. Studies have shown that TBS may also be useful to measure bone quality in patients with CKD-MBD [ 114 , 116 ]. Indeed, in CKD patient, TBS was significantly associated with the histologic parameters of trabecular bone volume and trabecular spacing but not with dynamic parameters, suggesting that TBS reflects trabecular microarchitecture and cortical width [ 117 ].…”

Section: Bone Fracture In Ckdmentioning

confidence: 99%

Bone Disease in Chronic Kidney Disease and Kidney Transplant

2022

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Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures and vascular disease, which ultimately result in high morbidity and mortality. The bone component of CKD-MBD, referred to as renal osteodystrophy, starts early during the course of CKD as a result of the effects of progressive reduction in kidney function which modify the tight interaction between mineral, hormonal, and other biochemical mediators of cell function that ultimately lead to bone disease. In addition, other factors, such as osteoporosis not apparently dependent on the typical pathophysiologic abnormalities resulting from altered kidney function, may accompany the different varieties of renal osteodystrophy leading to an increment in the risk of bone fracture. After kidney transplantation, these bone alterations and others directly associated or not with changes in kidney function may persist, progress or transform into a different entity due to new pathogenetic mechanisms. With time, these alterations may improve or worsen depending to a large extent on the restoration of kidney function and correction of the metabolic abnormalities developed during the course of CKD. In this paper, we review the bone lesions that occur during both CKD progression and after kidney transplant and analyze the factors involved in their pathogenesis as a means to raise awareness of their complexity and interrelationship.

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Management of osteoporosis in patients with chronic kidney disease

Cited by 28 publications

References 159 publications

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Trabecular bone score and phalangeal quantitative ultrasound are associated with muscle strength and fracture risk in hemodialysis patients

Iron Deficiency and Iron Deficiency Anemia: Potential Risk Factors in Bone Loss

Bone Disease in Chronic Kidney Disease and Kidney Transplant

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