Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Abstract

Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD.

Circulating p-Cresyl Sulfate, Non-Hepatic Alkaline Phosphatase and Risk of Bone Fracture Events in Chronic Kidney Disease-Mineral Bone Disease

“…Beyond the risk factor of age, the evaluation of BF risk was not simply the same as the general population due to high prevalence of multiple comorbidities and an altered microenvironment for bone in CKD-MBD, e.g., uremic burden, anemia, malnutrition-inflammation complex syndrome, hyperphosphatemia and SHPT, etc. [ 19 , 23 ]. Indeed, conventional risk factors for BFs, such as gender and DM, did not show significant results in univariate and multivariate Cox regression models.…”

Fat-Bone Relationship in Chronic Kidney Disease—Mineral Bone Disorders: Adiponectin Is Associated with Skeletal Events among Hemodialysis Patients

“…Beyond the risk factor of age, the evaluation of BF risks was not simply the same as the general population due to high prevalence of multiple comorbidity and altered microenvironment for bone in CKD-MBD, e.g., uremic burden, hyperphosphatemia, hypocalcemia, secondary hyperparathyroidism, hypovitaminosis D, anemia, and protein-energy wasting, etc. [ 24 ]. Indeed, conventional risk factors for BFs, such as gender and DM, did not show significant results in the univariate Cox regression model.…”

Adiponectin in Chronic Kidney Disease

“…This is due to the kidney’s pivotal role in activated vitamin D, parathormone, phosphatonins, calcium, and phosphorus regulation. CKD related mineral and bone disorders also include abnormalities in bone turnover, mineralization, and mass, causing greater fracture risk [ 84 ]. Experimental data have suggested a positive effect of adiponectin upon stabilization of atherosclerotic plaques in various mechanisms [ 85 ].…”