Bone Density Is Directly Associated With Glomerular Filtration and Metabolic Acidosis but Do Not Predict Fragility Fractures in Men With Moderate Chronic Kidney Disease

Lima, Guilherme Alcantara Cunha; Paranhos-Neto, Francisco de Paula; Silva, Luciana Colonese; Mendonça, Laura Maria Carvalho de; Delgado, Alvimar G.; Leite, Maurilo; Gomes, Carlos Perez; Farias, Maria Lúcia Fleiuss

doi:10.1016/j.jocd.2014.01.010

Cited by 9 publications

(8 citation statements)

References 55 publications

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“…Fractures in early‐stage CKD patients (stages 1–3 A CKD) are more resemblance as traditional osteoporosis rather than CKD‐MBD . However, most patients in stage 4 or 5 CKD exhibit certain degree of decreased bone mineral density (BMD) and/or certain level of CKD‐MBD . At the time of dialysis initiation, as many as up to half of the patients, might have experienced a fracture .…”

Section: Renal Osteodystrophymentioning

confidence: 99%

“…85,86 However, most patients in stage 4 or 5 CKD exhibit certain degree of decreased bone mineral density (BMD) and/or certain level of CKD-MBD. 87,88 At the time of dialysis initiation, as many as up to half of the patients, might have experienced a fracture. 89 Together, vitamin D deficiency, poor nutrition, inactivity, myopathy, and peripheral neuropathy play a role in muscle weakness and falls.…”

Section: Renal Osteodystrophymentioning

confidence: 99%

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Mineral bone disorders in chronic kidney disease

Hou

2018

Nephrology

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As the GFR loss aggravates, the disturbed mineral metabolism worsens the bone microstructure and remodelling ‐ scenario, which is known as CKD‐mineral bone disease (MBD). CKD‐MBD is characterized by : (i) abnormal metabolism of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D; (ii) abnormalities in bone turnover, mineralization, volume linear growth or strength; (iii) soft‐tissue calcifications, either vascular or extra‐osseous. Uremic vascular calcification and osteoporosis are the most common complications related to CKD‐MBD. Disregulated bone turnover by uremic toxin or secondary hyperparathyroidism disturbed bone mineralization and makes it difficult for calcium and inorganic phosphate to enter into bone, resulting in increased serum calcium and inorganic phosphate. Vascular calcification worsens by hyperphosphatemia and systemic inflammation. Since vitamin D deficiency plays an important role in renal osteodystrophy, supplement of nutritional vitamin D is important in treating uremic osteoporosis and vascular calcification at the same time. Its pleotropic effect improves the bone remodeling initiated by osteoblast and alleviates the risk factors for vascular calcification with less hypercalcemia than vitamin D receptor analogs. Therefore, nutritional vitamin D should be considered in managing CKDMBD.

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Section: Renal Osteodystrophymentioning

confidence: 99%

Section: Renal Osteodystrophymentioning

confidence: 99%

Mineral bone disorders in chronic kidney disease

Hou

2018

Nephrology

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“…(30) reported that patients with CKD may present advanced bone disease with a high risk of fractures despite having normal or even high BMD. In a recent study of male patients with grade 3 and 4 CKD, we found that only 3.9% of them had osteoporosis by DXA, but 31.4% reported low-impact fractures, confirming the ineffectiveness of this method in predicting bone fragility in CKD (11). Due to the inconsistency of the DXA results in CKD patients undergoing conservative treatment, as well as in the dialysis population, the official position of the international consensus KDIGO (1) is that, for patients with stage 3b-5 (GFR < 45 mL/min/1.73 m 2 ), DXA should not be used due of its inability to predict fractures and determine the type of renal osteodystrophy, and because it can provide misleading information about the bone health of these patients.…”

Section: Bone Evaluation In Ckdmentioning

confidence: 63%

“…However, in patients with CKD, its effectiveness in identifying bone fragility and predicting fractures is uncertain (1). Studies with CKD patients in conservative treatment have shown conflicting results (4)(5)(6)(7)(8)(9)(10)(11)18), as summarized in (4,(8)(9)(10)(11), as also shown in table 3. Jassal and cols.…”

Section: Bone Evaluation In Ckdmentioning

confidence: 99%

Osteoporosis management in patient with renal function impairment

Lima

Paranhos-Neto

Pereira

et al. 2014

Arq Bras Endocrinol Metab

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Aging is associated with decreases in bone quality and in glomerular filtration. Consequently, osteoporosis and chronic kidney disease (CKD) are common comorbid conditions in the elderly, and often coexist. Biochemical abnormalities in the homeostasis of calcium and phosphorus begin early in CKD, leading to an increase in fracture risk and cardiovascular complications since early stages of the disease. The ability of DXA (dual energy X-ray absorptiometry) to diagnose osteoporosis and to predict fractures in this population remains unclear. The management of the disease is also controversial: calcium and vitamin D, although recommended, must be prescribed with caution, considering vascular calcification risk and the development of adynamic bone disease. Furthermore, safety and effectiveness of osteoporosis drugs are not established in patients with CKD. Thus, risks and benefits of antiosteoporosis treatment must be considered individually. RESUMOO envelhecimento associa-se tanto ao declínio da qualidade óssea quanto da filtração glomerular. Consequentemente, osteoporose e doença renal crônica (DRC) são comorbidades frequentes em idosos, e muitas vezes coexistem. Anormalidades bioquímicas na homeostase do cálcio e do fósforo surgem precocemente na DRC, causando aumento do risco de fraturas e de complicações cardiovasculares desde fases precoces da doença. A capacidade da densitometria (DXA) em diagnosticar osteoporose e predizer fraturas nessa população é questionável. O manejo da doença é também controverso; cálcio e vitamina D são recomendados com cautela, devido ao risco de calcificações vasculares e de doença óssea adinâmica. Além disso, a segurança e a eficácia dos medicamentos para osteoporose ainda não estão estabelecidas em pacientes com DRC. Assim, riscos e benefícios do tratamento para osteoporose devem ser considerados individualmente nesses pacientes. Arq Bras Endocrinol Metab. 2014;58(5):530-9 Descritores Qualidade

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“…5 Several studies have demonstrated a correlation between serum bicarbonate with nutritional status and CKD-related bone disorders. 4,[6][7][8] In the present study, we aimed to investigate the associations between the 2 main components of metabolic acidosis (UA and reduced SID) with serum albumin and iPTH.…”

Section: Introductionmentioning

confidence: 99%