Consensus Evidence-Based Clinical Practice Recommendations for the Diagnosis and Treat-To-Target Management of Osteoporosis in Chronic Kidney Disease Stages G4-G5D and Post-transplantation: An Initiative of Egyptian Academy of Bone Health

Abstract

<b><i>Objective:</i></b> The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. <b><i>Methods:</i></b> Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts’ suggestions, and the percent agreement was calculated. Statements receiving rates of 7–9 by more than 75% of experts’ votes were considered as achieving consensus. <b><i>Results:</i></b> The surveys were sent to an expert panel (<i>n</i> = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. <b><i>Conclusion:</i></b> A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

“…Both chronic kidney disease (CKD) and osteoporotic hip fractures (HF) are major and steadily rising public health problems globally, afecting 843.6 [1,2] and 14.2 [3] (4.5 million people with HF per year worldwide [4]) million individuals, respectively, and contributing to high morbidity, mortality, and excess health and social care costs [5][6][7][8][9][10][11][12]. Both pathologies are bidirectionally interrelated: CKD compromises bone-mineral status and predisposes to falls and vice versa [7,[13][14][15][16].…”

“…Te relationship between kidney function and postoperative outcomes in hip fracture (HF) patients has not been systematically investigated, and the few studies that evaluated the input of CKD on HF outcomes have yielded conficting results [25][26][27][28][29]. Despite the great interest in predicting the risk of fracture and identifying people who will beneft from therapeutic interventions, data on the use, effectiveness, and safety of anti-osteoporotic drugs in patients with diferent stages of CKD is also scarce and uncertain [9,12,[30][31][32][33][34][35][36]. Terefore, in this study, we aimed to assess the prevalence of CKD among patients with HF (compared to the general population) and the impact of CKD on HF outcomes (hospital mortality and length of stay [LOS]) with the inclusion of additional efects of age, gender, degree of renal dysfunction, and comorbidities.…”