Diagnosis and Management of Osteoporosis in Chronic Kidney Disease Stages 4 to 5D: a Call for a Shift from Nihilism to Pragmatism

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2021 Jun 15

PMID 34129059

Citations 12

Authors

P Evenepoel

J Cunningham

S Ferrari

M Haarhaus

M K Javaid

M-H Lafage-Proust

D Prieto-Alhambra

P U Torres

J Cannata-Andia

Affiliations

Soon will be listed here.

Abstract

The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) CKD-MBD working group, in collaboration with the Committee of Scientific Advisors of the International Osteoporosis Foundation, published a position paper for the diagnosis and management of osteoporosis in patients with CKD stages 4-5D (eGFR < 30 ml/min 1.73 m). The present article reports and summarizes the main recommendations included in this 2021 document. The following areas are reviewed: diagnosis of osteoporosis; risk factors for fragility fractures; fracture risk assessment; intervention thresholds for pharmacological intervention; general and pharmacological management of osteoporosis; monitoring of treatment, and systems of care, all in patients with CKD stages 4-5D. Guidance is provided for clinicians caring for CKD stages 4-5D patients with osteoporosis, allowing for a pragmatic individualized diagnostic and therapeutic approach as an alternative to current variations in care and treatment nihilism.

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References

Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K . Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006; 69(11):1945-53. DOI: 10.1038/sj.ki.5000414. View

Kanis J, Cooper C, Rizzoli R, Reginster J . European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2018; 30(1):3-44. PMC: 7026233. DOI: 10.1007/s00198-018-4704-5. View

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J . Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations.... Arch Osteoporos. 2013; 8:136. PMC: 3880487. DOI: 10.1007/s11657-013-0136-1. View

Moe S, Nickolas T . Fractures in Patients with CKD: Time for Action. Clin J Am Soc Nephrol. 2016; 11(11):1929-1931. PMC: 5108207. DOI: 10.2215/CJN.09500916. View

Evenepoel P, Cunningham J, Ferrari S, Haarhaus M, Javaid M, Lafage-Proust M . European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4-G5D. Nephrol Dial Transplant. 2020; 36(1):42-59. DOI: 10.1093/ndt/gfaa192. View

Miller P . Chronic kidney disease and osteoporosis: evaluation and management. Bonekey Rep. 2014; 3:542. PMC: 4078413. DOI: 10.1038/bonekey.2014.37. View

Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T . Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study. Nephrol Dial Transplant. 2011; 27(1):345-51. DOI: 10.1093/ndt/gfr317. View

Yenchek R, Ix J, Shlipak M, Bauer D, Rianon N, Kritchevsky S . Bone mineral density and fracture risk in older individuals with CKD. Clin J Am Soc Nephrol. 2012; 7(7):1130-6. PMC: 3386677. DOI: 10.2215/CJN.12871211. View

Naylor K, Garg A, Zou G, Langsetmo L, Leslie W, Fraser L . Comparison of fracture risk prediction among individuals with reduced and normal kidney function. Clin J Am Soc Nephrol. 2015; 10(4):646-53. PMC: 4386249. DOI: 10.2215/CJN.06040614. View

10.

West S, Lok C, Langsetmo L, Cheung A, Szabo E, Pearce D . Bone mineral density predicts fractures in chronic kidney disease. J Bone Miner Res. 2014; 30(5):913-9. DOI: 10.1002/jbmr.2406. View

11.

Ketteler M, Block G, Evenepoel P, Fukagawa M, Herzog C, McCann L . Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int. 2017; 92(1):26-36. DOI: 10.1016/j.kint.2017.04.006. View

12.

Maruyama Y, Taniguchi M, Kazama J, Yokoyama K, Hosoya T, Yokoo T . A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan. Nephrol Dial Transplant. 2014; 29(8):1532-8. DOI: 10.1093/ndt/gfu055. View

13.

Coco M, Rush H . Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis. 2000; 36(6):1115-21. DOI: 10.1053/ajkd.2000.19812. View

14.

Jadoul M, Albert J, Akiba T, Akizawa T, Arab L, Bragg-Gresham J . Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2006; 70(7):1358-66. DOI: 10.1038/sj.ki.5001754. View

15.

Danese M, Kim J, Doan Q, Dylan M, Griffiths R, Chertow G . PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis. 2005; 47(1):149-56. DOI: 10.1053/j.ajkd.2005.09.024. View

16.

Malluche H, Monier-Faugere M, Blomquist G, Davenport D . Two-year cortical and trabecular bone loss in CKD-5D: biochemical and clinical predictors. Osteoporos Int. 2017; 29(1):125-134. DOI: 10.1007/s00198-017-4228-4. View

17.

Aleksova J, Kurniawan S, Elder G . The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease. Osteoporos Int. 2018; 29(6):1447-1455. DOI: 10.1007/s00198-018-4468-y. View

18.

Naylor K, Prior J, Garg A, Berger C, Langsetmo L, Adachi J . Trabecular Bone Score and Incident Fragility Fracture Risk in Adults with Reduced Kidney Function. Clin J Am Soc Nephrol. 2016; 11(11):2032-2040. PMC: 5108183. DOI: 10.2215/CJN.00720116. View

19.

Jamal S, Gilbert J, Gordon C, Bauer D . Cortical pQCT measures are associated with fractures in dialysis patients. J Bone Miner Res. 2006; 21(4):543-8. DOI: 10.1359/jbmr.060105. View

20.

Bielesz B, Patsch J, Fischer L, Bojic M, Winnicki W, Weber M . Cortical porosity not superior to conventional densitometry in identifying hemodialysis patients with fragility fracture. PLoS One. 2017; 12(2):e0171873. PMC: 5310770. DOI: 10.1371/journal.pone.0171873. View