http://www.ncbi.nlm.nih.gov/pubmed/24991405
Bonekey Rep. 2014 Jun 25;3:542. doi: 10.1038/bonekey.2014.37. eCollection 2014.
Fractures across the stages of chronic kidney disease (CKD) could be due to osteoporosis, some form of renal osteodystrophy defined by specific quantitative histomorphometry or chronic kidney disease-mineral and bone disorder (CKD-MBD). CKD-MBD is a systemic disease that links disorders of mineral and bone metabolism due to CKD to either one or all of the following: abnormalities of calcium, phosphorus, parathyroid hormone or vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth or strength; or vascular or other soft-tissue calcification. Osteoporosis, as defined by The National Institutes of Health, may coexist with renal osteodystrophy or CKD-MBD.
Bonekey Rep. 2014 Jun 25;3:542. doi: 10.1038/bonekey.2014.37. eCollection 2014.
Fractures across the stages of chronic kidney disease (CKD) could be due to osteoporosis, some form of renal osteodystrophy defined by specific quantitative histomorphometry or chronic kidney disease-mineral and bone disorder (CKD-MBD). CKD-MBD is a systemic disease that links disorders of mineral and bone metabolism due to CKD to either one or all of the following: abnormalities of calcium, phosphorus, parathyroid hormone or vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth or strength; or vascular or other soft-tissue calcification. Osteoporosis, as defined by The National Institutes of Health, may coexist with renal osteodystrophy or CKD-MBD.
Differentiation among these disorders is required to manage correctly
the correct disorder to reduce the risk of fractures. While the World
Health Organization (WHO) BMD criteria for osteoporosis can be used in
patients with stages 1-3 CKD, the disorders of bone turnover become so
aberrant by stages 4 and 5 CKD that neither the WHO criteria nor the
occurrence of a fragility fracture can be used for the diagnosis of
osteoporosis. The diagnosis of osteoporosis in stages 4 and 5 CKD is one
of exclusion--excluding either renal osteodystrophy or CKD-MBD as
the cause of low BMD or fragility fractures. Differentiations among the
disorders of renal osteodystrophy, CKD-MBD or osteoporosis are dependent
on the measurement of specific biochemical markers, including serum
parathyroid hormone (PTH) and/or quantitative bone histomorphometry.
Management of fractures in stages 1-3 CKD does not differ in persons
with or without CKD with osteoporosis assuming there is no evidence for
CKD-MBD, clinically suspected by elevated PTH, hyperphosphatemia or
fibroblast growth factor 23 due to CKD. Treatment of fractures in
persons with osteoporosis and stages 4 and 5 CKD is not evidence based,
with the exception of post hoc analysis suggesting efficacy and safety
of specific osteoporosis therapies (alendronate, risedronate and
denosumab) in stage 4 CKD. This review also discusses how to diagnose
and manage fragility fractures across the five stages of CKD.
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