Abstract
Osteoporosis affects a segment of the population in which Chronic Kidney Disease is also greatly represented. Nephropathic patients may present peculiar biochemical abnormalities related to Chronic Kidney Disease, defining the Mineral and Bone Disorder. This kind of anomalies, in the worst scenarios, configure the typical histomorphology patterns of Renal Osteodystrophy. Scientific Societies of Endocrinology have established therapy guidelines for patients with osteoporosis only based on the glomerular filtration rate and recommend avoiding the use of some drugs for the more advanced classes of nephropathy. However, there is no clear therapeutic approach for patients with advanced nephropathy and bone abnormalities. In this paper we propose a systematic review of the literature and present our proposal for managing patients with advanced nephropathy, based on eGFR and on presence of Mineral and Bone Disorder.
Keywords:
CKD-MBD; bisphosphonates; chronic kidney disease-mineral and bone disorder; osteoporosis; uremic osteodystrophy.
Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.
MeSH terms
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Antibodies, Monoclonal / therapeutic use
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Bone Density Conservation Agents / adverse effects
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Bone Density Conservation Agents / chemistry
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Bone Density Conservation Agents / therapeutic use*
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Chronic Kidney Disease-Mineral and Bone Disorder / drug therapy*
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Chronic Kidney Disease-Mineral and Bone Disorder / etiology
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Chronic Kidney Disease-Mineral and Bone Disorder / physiopathology
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Contraindications
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Denosumab / therapeutic use
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Diphosphonates / adverse effects
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Diphosphonates / chemistry
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Diphosphonates / therapeutic use*
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Female
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Fractures, Spontaneous / drug therapy
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Fractures, Spontaneous / etiology
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Fractures, Spontaneous / prevention & control
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Glomerular Filtration Rate
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Humans
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Male
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Osteoporosis / complications
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Osteoporosis / diagnosis
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Osteoporosis / drug therapy*
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Parathyroid Hormone-Related Protein / therapeutic use
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Practice Guidelines as Topic
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Renal Insufficiency, Chronic / complications*
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Renal Insufficiency, Chronic / physiopathology
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Risk Factors
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Teriparatide / therapeutic use
Substances
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Antibodies, Monoclonal
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Bone Density Conservation Agents
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Diphosphonates
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Parathyroid Hormone-Related Protein
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Teriparatide
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romosozumab
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Denosumab
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abaloparatide