Osteoporosis, bone mineral density and CKD-MBD complex (I): Diagnostic considerations
Nefrologia (Engl Ed). 2018 Sep-Oct;38(5):476-490.
doi: 10.1016/j.nefro.2017.12.006.
Epub 2018 Apr 24.
[Article in
English,
Spanish]
Authors
Jordi Bover
1
, Pablo Ureña-Torres
2
, Josep-Vicent Torregrosa
3
, Minerva Rodríguez-García
4
, Cristina Castro-Alonso
5
, José Luis Górriz
6
, Ana María Laiz Alonso
7
, Secundino Cigarrán
8
, Silvia Benito
9
, Víctor López-Báez
9
, María Jesús Lloret Cora
9
, Iara daSilva
9
, Jorge Cannata-Andía
10
Affiliations
- 1 Fundació Puigvert, Servicio de Nefrología, IIB Sant Pau, REDinREN, Barcelona, España. Electronic address: [email protected].
- 2 Ramsay-Générale de Santé, Clinique du Landy, Department of Nephrology and Dialysis and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, París, Francia.
- 3 Servicio de Nefrología, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, España.
- 4 Servicio de Nefrología, Hospital Universitario Central de Asturias, REDinREN, Universidad de Oviedo, Oviedo, España.
- 5 Servicio de Nefrología, Hospital Dr. Peset, Valencia, España.
- 6 Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, España.
- 7 Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
- 8 Servicio de Nefrología, Hospital da Costa de Burela, Lugo, España.
- 9 Fundació Puigvert, Servicio de Nefrología, IIB Sant Pau, REDinREN, Barcelona, España.
- 10 Unidad de Gestión Clínica de Servicio de Metabolismo Óseo, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, REDinREN, Universidad de Oviedo, Oviedo, España.
Abstract
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.
Keywords:
Bone mineral density; CKD-MBD; Chronic kidney disease; DEXA; Densidad mineral ósea; Enfermedad renal crónica; FRAX; Fracturas; Fractures; Osteoporosis.
Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.
Publication types
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Research Support, Non-U.S. Gov't
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Review
MeSH terms
-
Bone Density*
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Chronic Kidney Disease-Mineral and Bone Disorder / diagnosis*
-
Humans
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Osteoporosis / diagnosis*
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Osteoporosis / etiology
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Osteoporotic Fractures / epidemiology
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Osteoporotic Fractures / etiology
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Renal Insufficiency, Chronic / complications
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Risk Factors