Osteoporosis in chronic kidney disease: A essential challenge

Casado, Enrique; Bover, Jordi; Gómez‐Alonso, Carlos; Navarro‐González, Juan F.

doi:10.1016/j.medcle.2021.05.007

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…New guidelines suggest that BMD should also be assessed in CKD patients if results will impact clinical decisions (i.e., individualized prescription of anti-OP drugs). Several illustrative algorithms for CKD patients have already been published, broadly calling for a shift from nihilism to pragmatism (Pimentel et al, 2017;Evenepoel et al, 2021b;Evenepoel et al, 2021c;Pimentel et al, 2021;Casado et al, 2022;Ginsberg and Ix, 2022;Haarhaus et al, 2022). However, it is still prudent to use these drugs (bisphosphonates, denosumab, recombinant PTH and romosozumab) with caution, especially in advanced kidney disease, balancing the risk/ benefit ratio, since, as documented in this article, pathophysiological pathways are extremely intricate and not completely unraveled yet.…”

Section: Denosumab and Romosozumabmentioning

confidence: 97%

Pathophysiology of Bone and Mineral Metabolism

2024

Frontiers Research Topics

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Frontiers is more than just an open access publisher of scholarly articles: it is a pioneering approach to the world of academia, radically improving the way scholarly research is managed. The grand vision of Frontiers is a world where all people have an equal opportunity to seek, share and generate knowledge. Frontiers provides immediate and permanent online open access to all its publications, but this alone is not enough to realize our grand goals. Frontiers journal seriesThe Frontiers journal series is a multi-tier and interdisciplinary set of openaccess, online journals, promising a paradigm shift from the current review, selection and dissemination processes in academic publishing. All Frontiers journals are driven by researchers for researchers; therefore, they constitute a service to the scholarly community. At the same time, the Frontiers journal series operates on a revolutionary invention, the tiered publishing system, initially addressing specific communities of scholars, and gradually climbing up to broader public understanding, thus serving the interests of the lay society, too. Dedication to qualityEach Frontiers article is a landmark of the highest quality, thanks to genuinely collaborative interactions between authors and review editors, who include some of the world's best academicians. Research must be certified by peers before entering a stream of knowledge that may eventually reach the public -and shape society; therefore, Frontiers only applies the most rigorous and unbiased reviews. Frontiers revolutionizes research publishing by freely delivering the most outstanding research, evaluated with no bias from both the academic and social point of view. By applying the most advanced information technologies, Frontiers is catapulting scholarly publishing into a new generation. What are Frontiers Research Topics?Frontiers Research Topics are very popular trademarks of the Frontiers journals series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area.

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Section: Denosumab and Romosozumabmentioning

confidence: 97%

Pathophysiology of Bone and Mineral Metabolism

2024

Frontiers Research Topics

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“…The primary motivation for this revision was the growing experience with osteoporosis medications in patients with CKD, low BMD, and a high risk of fracture and the recognition that the lack of ability to perform a bone biopsy (previously suggested) may not justify withholding antiresorptive therapy [ 39 , 67 ]. Multiple algorithms, society endorsements, and consensus documents followed on the diagnosis and management of osteoporosis in CKD [ 40 , 62 , 63 , 82 , 83 ], including at advanced CKD stages and in dialysis patients [ 61 ]. Not only should vitamin D supplements be considered when initiating osteoporosis treatments, but an adequate calcium intake should also be evaluated and reinforced since calcium intake in CKD patients is usually deficient and/or impaired [ 84 , 85 ].…”

Section: Kdigo Guidelines: From Vitamin D Deficiency To Osteoporosis ...mentioning

confidence: 99%

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

et al. 2023

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Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.

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“…New guidelines suggest that BMD should also be assessed in CKD patients if results will impact clinical decisions (i.e., individualized prescription of anti-OP drugs). Several illustrative algorithms for CKD patients have already been published, broadly calling for a shift from nihilism to pragmatism ( Pimentel et al, 2017 ; Evenepoel et al, 2021b ; Evenepoel et al, 2021c ; Pimentel et al, 2021 ; Casado et al, 2022 ; Ginsberg and Ix, 2022 ; Haarhaus et al, 2022 ). However, it is still prudent to use these drugs (bisphosphonates, denosumab, recombinant PTH and romosozumab) with caution, especially in advanced kidney disease, balancing the risk/benefit ratio, since, as documented in this article, pathophysiological pathways are extremely intricate and not completely unraveled yet.…”

Section: Denosumab and Romosozumabmentioning

confidence: 99%

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

Aguilar,

Gifre,

Ureña-Torres

et al. 2023

Front. Physiol.

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Chronic kidney disease (CKD) is a highly prevalent disease that has become a public health problem. Progression of CKD is associated with serious complications, including the systemic CKD-mineral and bone disorder (CKD-MBD). Laboratory, bone and vascular abnormalities define this condition, and all have been independently related to cardiovascular disease and high mortality rates. The “old” cross-talk between kidney and bone (classically known as “renal osteodystrophies”) has been recently expanded to the cardiovascular system, emphasizing the importance of the bone component of CKD-MBD. Moreover, a recently recognized higher susceptibility of patients with CKD to falls and bone fractures led to important paradigm changes in the new CKD-MBD guidelines. Evaluation of bone mineral density and the diagnosis of “osteoporosis” emerges in nephrology as a new possibility “if results will impact clinical decisions”. Obviously, it is still reasonable to perform a bone biopsy if knowledge of the type of renal osteodystrophy will be clinically useful (low versus high turnover-bone disease). However, it is now considered that the inability to perform a bone biopsy may not justify withholding antiresorptive therapies to patients with high risk of fracture. This view adds to the effects of parathyroid hormone in CKD patients and the classical treatment of secondary hyperparathyroidism. The availability of new antiosteoporotic treatments bring the opportunity to come back to the basics, and the knowledge of new pathophysiological pathways [OPG/RANKL (LGR4); Wnt-ß-catenin pathway], also affected in CKD, offers great opportunities to further unravel the complex physiopathology of CKD-MBD and to improve outcomes.

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Osteoporosis in chronic kidney disease: A essential challenge

Cited by 6 publications

References 27 publications

Pathophysiology of Bone and Mineral Metabolism

Pathophysiology of Bone and Mineral Metabolism

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

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