Longitudinal Bone Loss Occurs at the Radius in CKD

Cailleaux, Pierre-Emmanuel; Ostertag, Agnès; Metzger, Marie; Stengel, Bénédicte; Boucquemont, Julie; Houillier, Pascal; Flamant, Martin; Ureña-Torres, Pablo; Cohen‐Solal, Martine

doi:10.1016/j.ekir.2021.03.874

Cited by 11 publications

(9 citation statements)

References 47 publications

(80 reference statements)

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“…Thus, cross-sectional analysis showed a significantly lower BMD at femoral neck and total hip and a significant higher serum PTH along with CKD stages ( Cailleaux et al, 2021 ). Baseline age, gender, low body mass index, tobacco, and high PTH levels were significantly associated with low BMD ( Cailleaux et al, 2021 ). Interestingly, the longitudinal bone loss observed in patients with CKD during the mean 4.3-year follow-up revealed a significant bone loss at the radius only, whereas BMD changes at the femoral neck were not associated with CKD stages or basal PTH levels ( Cailleaux et al, 2021 ).…”

Section: Osteoporosismentioning

confidence: 99%

“…Baseline age, gender, low body mass index, tobacco, and high PTH levels were significantly associated with low BMD ( Cailleaux et al, 2021 ). Interestingly, the longitudinal bone loss observed in patients with CKD during the mean 4.3-year follow-up revealed a significant bone loss at the radius only, whereas BMD changes at the femoral neck were not associated with CKD stages or basal PTH levels ( Cailleaux et al, 2021 ). These data invite to a better definition of the skeletal site and the monitoring schedule of serial BMD measurements in patients with CKD, and to investigate the changes of BMD and microarchitecture with high-resolution techniques, which may broaden the understanding and differential role of PTH on trabecular and cortical bone, especially in CKD patients ( Cailleaux et al, 2021 ).…”

Section: Osteoporosismentioning

confidence: 99%

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Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

Aguilar,

Gifre,

Ureña-Torres

et al. 2023

Front. Physiol.

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Chronic kidney disease (CKD) is a highly prevalent disease that has become a public health problem. Progression of CKD is associated with serious complications, including the systemic CKD-mineral and bone disorder (CKD-MBD). Laboratory, bone and vascular abnormalities define this condition, and all have been independently related to cardiovascular disease and high mortality rates. The “old” cross-talk between kidney and bone (classically known as “renal osteodystrophies”) has been recently expanded to the cardiovascular system, emphasizing the importance of the bone component of CKD-MBD. Moreover, a recently recognized higher susceptibility of patients with CKD to falls and bone fractures led to important paradigm changes in the new CKD-MBD guidelines. Evaluation of bone mineral density and the diagnosis of “osteoporosis” emerges in nephrology as a new possibility “if results will impact clinical decisions”. Obviously, it is still reasonable to perform a bone biopsy if knowledge of the type of renal osteodystrophy will be clinically useful (low versus high turnover-bone disease). However, it is now considered that the inability to perform a bone biopsy may not justify withholding antiresorptive therapies to patients with high risk of fracture. This view adds to the effects of parathyroid hormone in CKD patients and the classical treatment of secondary hyperparathyroidism. The availability of new antiosteoporotic treatments bring the opportunity to come back to the basics, and the knowledge of new pathophysiological pathways [OPG/RANKL (LGR4); Wnt-ß-catenin pathway], also affected in CKD, offers great opportunities to further unravel the complex physiopathology of CKD-MBD and to improve outcomes.

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Section: Osteoporosismentioning

confidence: 99%

Section: Osteoporosismentioning

confidence: 99%

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

Aguilar,

Gifre,

Ureña-Torres

et al. 2023

Front. Physiol.

Self Cite

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“…CKD-related bone fragility associated with either osteopenia or osteoporosis is two to three times more frequent in CKD patients than in the general population [ 18 , 19 , 20 ]. Then, in spite of the progress made in the management of CKD and in dialysis techniques, the risk of bone fractures at any skeletal site increases with the severity of CKD, age, and dialysis vintage [ 1 , 21 , 22 , 23 ].…”

Section: Epidemiology Of Bone Fractures In Ckdmentioning

confidence: 99%

Bone Fragility in Chronic Kidney Disease Stage 3 to 5: The Use of Vitamin D Supplementation

2022

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Frequently silent until advanced stages, bone fragility associated with chronic kidney disease-mineral and bone disease (CKD-MBD) is one of the most devastating complications of CKD. Its pathophysiology includes the reduction of active vitamin D metabolites, phosphate accumulation, decreased intestinal calcium absorption, renal alpha klotho production, and elevated fibroblast growth factor 23 (FGF23) levels. Altogether, these factors contribute firstly to secondary hyperparathyroidism, and ultimately, to micro- and macrostructural bone changes, which lead to low bone mineral density and an increased risk of fracture. A vitamin D deficiency is common in CKD patients, and low circulating 25(OH)D levels are invariably associated with high serum parathyroid hormone (PTH) levels as well as with bone mineralization defects, such as osteomalacia in case of severe forms. It is also associated with a variety of non-skeletal diseases, including cardiovascular disease, diabetes mellitus, multiple sclerosis, cancer, and reduced immunological response. Current international guidelines recommend supplementing CKD patients with nutritional vitamin D as in the general population; however, there is no randomized clinical trial (RCT) evaluating the effect of vitamin D (or vitamin D+calcium) supplementation on the risk of fracture in the setting of CKD. It is also unknown what level of circulating 25(OH)D would be sufficient to prevent bone abnormalities and fractures in these patients. The impact of vitamin D supplementation on other surrogate endpoints, including bone mineral density and bone-related circulating biomarkers (PTH, FGF23, bone-specific alkaline phosphatase, sclerostin) has been evaluated in several RTCs; however, the results were not always translated into an improvement in long-term outcomes, such as reduced fracture risk. This review provides a brief and comprehensive update on CKD-related bone fragility and the use of natural vitamin D supplementation in these patients.

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“…With longitudinal follow-up in patients with CKD stage 3–5 and with measured GFR and BMD follow-up, a slight bone loss occurs at the radius only, a cortical bone. 64 However, because the levels of bone loss remain unknown, the frequency of serial BMD assessments remains to be determined. Therefore, the European Dialysis and Transplant Association and the IOF integrate the evaluation of fracture risk as a target in the management of CKD-MBD.…”

Section: Need For Novel Comprehensive Approach In Concomitant Decline...mentioning

confidence: 99%

Managing Musculoskeletal and Kidney Aging: A Call for Holistic Insights

Cailleaux¹,

Cohen‐Solal²

2022

CIA

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Aging represents a major concern, with a two-fold increase in individuals >65 years old by 2040. Older patients experience multiple declines in condition, with overlapping concerns. Fractures, frailty and falls remain underestimated events in routine practice. They are shared by numerous conditions and diseases, such as osteoporosis, sarcopenia and undernutrition, which mostly feature low evolution and are silent. In this review, we focused on musculoskeletal decline in older individuals who also have chronic kidney disease (CKD), which promotes fractures and falls. We aimed to highlight the need for a global approach for musculoskeletal and kidney aging. Although strategies limiting falls remain controversial, the need for an early diagnosis can limit these declines and allow for specific treatment of bone fragility in addition to non-pharmacological approaches. The emergence of senolytic agents offers new hope for preventing musculoskeletal disorders. This scoping review describes these overlapping silent diseases, provides evidence for their global understanding and management, and sheds light on new therapeutic directions.

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Longitudinal Bone Loss Occurs at the Radius in CKD

Cited by 11 publications

References 47 publications

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

Bone Fragility in Chronic Kidney Disease Stage 3 to 5: The Use of Vitamin D Supplementation

Managing Musculoskeletal and Kidney Aging: A Call for Holistic Insights

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