Osteoporosis: Chronic Kidney Disease in Rheumatology Practice

Césini, Johann; Cheriet, Sarah; Breuil, Véronique; Lafage-Proust, Marie-Hélène

doi:10.1016/s1297-319x(12)70017-9

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…Depending the type of osteodystrophy, the levels PTH and alkaline phosphatase (ALP) may be lowered or elevated, indicating a low or high bone turnover, respectively. Hence, a global distinction can be made between secondary hyperparathyroidism (both parameters elevated) and adynamic bone (both parameters lowered) [3,8].…”

Section: Diagnosis Of Osteoporosis In Patients With Chronic Kidney DImentioning

confidence: 99%

“…A bone biopsy may be considered in an osteoporosis patient with CKD, for whom an indication exists for osteoporotic treatment and PTH is normal to mildly elevated [12]. In this case, it is important to differentiate between secondary hyperparathyroidism and adynamic bone (as both can occur with a normal PTH) [3]. If there is hyperparathyroidism, this should be treated in the first place: calcitriol or vitamin D analogs.…”

Section: Diagnosis Of Osteoporosis In Patients With Chronic Kidney DImentioning

confidence: 99%

“…The most common form of osteodystrophy is osteitis fibrosa [3], which is characterized by a high bone turnover as a result of a higher PTH level. The rise of PTH level is a reaction to hypocalcaemia, which occur as a result of inadequate renal conversion of 25-OH-D to 1,25-OH 2 -D (calcitriol) that occurs in renal failure [9].…”

mentioning

confidence: 99%

“…This condition occurs in patients with (pre) terminal renal failure, after prolonged vitamin D therapy, the use of phosphate binders containing calcium, PTH resistance in renal failure or after parathyroidectomy [3].…”

mentioning

confidence: 99%

“…This form is currently uncommon since aluminum-containing antacids are rarely used anymore as phosphate binders [3].…”

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confidence: 99%

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Treatment of osteoporosis in renal insufficiency

et al. 2015

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Patients with osteoporosis often have chronic kidney disease (CKD). CKD is associated with bone and mineral disturbances, renal osteodystrophy, which like osteoporosis leads to a higher risk of fractures. Bisphosphonates are first-line therapy for osteoporosis; however, these are contra-indicated in patients with a GFR <30 ml/min. In this article, we have reviewed the diagnosis and treatment of osteoporosis in moderate to severe renal failure from data of clinical trials. Results have shown that osteoporosis patients and severe CKD with no signs of renal osteodystrophy, oral bisphosphonates (risedronate) seem to be a safe choice. Renal function and PTH should subsequently be monitored strictly. Denosumab, with regularly monitoring of calcium and adequate vitamin D levels or raloxifene are a possible second choice. In any case, one should be certain that there is no adynamic bone before treatment can be started. If there is any doubt, bone biopsies should be taken.

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Section: Diagnosis Of Osteoporosis In Patients With Chronic Kidney DImentioning

confidence: 99%

Section: Diagnosis Of Osteoporosis In Patients With Chronic Kidney DImentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…This form is currently uncommon since aluminum-containing antacids are rarely used anymore as phosphate binders [3].…”

mentioning

confidence: 99%

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Treatment of osteoporosis in renal insufficiency

et al. 2015

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Osteoporosis, densidad mineral ósea y complejo CKD-MBD (I): consideraciones diagnósticas

et al. 2018

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Osteoporosis (OP) and chronic kidney disease (CKD) independently influence bone and cardiovascular health. A considerable number of patients with CKD, especially those with stages 3a to 5D, have a significantly reduced bone mineral density leading to a high risk of fracture and a significant increase in associated morbidity and mortality. Independently of classic OP related to age and/or gender, the mechanical properties of bone are also affected by inherent risk factors for CKD ("uraemic OP"). In the first part of this review, we will analyse the general concepts regarding bone mineral density, OP and fractures, which have been largely undervalued until now by nephrologists due to the lack of evidence and diagnostic difficulties in the context of CKD. It has now been proven that a reduced bone mineral density is highly predictive of fracture risk in CKD patients, although it does not allow a distinction to be made between the causes which generate it (hyperparathyroidism, adynamic bone disease and/or senile osteoporosis, etc.). Therefore, in the second part, we will analyse the therapeutic indications in different CKD stages. In any case, the individual assessment of factors which represent a higher or lower risk of fracture, the quantification of this risk (i.e. using tools such as FRAX) and the potential indications for densitometry in patients with CKD could represent an important first step pending new clinical guidelines based on randomised studies which do not exclude CKD patients, all the while avoiding therapeutic nihilism in an area of growing importance.

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