Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\24991405
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Bonekey+Rep
2014 ; 3
(ä): 542
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Chronic kidney disease and osteoporosis: evaluation and management
#MMPMID24991405
Miller PD
Bonekey Rep
2014[]; 3
(ä): 542
PMID24991405
show ga
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 the
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.