Rethinking Bone Disease in Kidney Disease

Abstract

Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD‐MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population. Furthermore, at a population level, fractures are at historically high levels in patients with end‐stage kidney disease (ESKD), whereas in contrast the general population has experienced a steady decline in fracture incidence rates. Based on these findings, it is clear that a paradigm shift is needed in our approach to diagnosing and managing ROD. In clinical practice, our ability to diagnose ROD and initiate antifracture treatments is impeded by the lack of accurate noninvasive methods that identify ROD type. The past decade has seen advances in the noninvasive measurement of bone quality and strength that have been studied in kidney disease patients. Below we review the current literature pertaining to the epidemiology, pathology, diagnosis, and management of ROD. We aim to highlight the pressing need for a greater awareness of this condition and the need for the implementation of strategies that prevent fractures in kidney disease patients. Research is needed for more accurate noninvasive assessment of ROD type, clinical studies of existing osteoporosis therapies in patients across the spectrum of kidney disease, and the development of CKD‐specific treatments. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

A Pooled Analysis of Serum Phosphate Measurements and Potential Hypophosphataemia Events in 45 Interventional Trials with Ferric Carboxymaltose

“…Musculoskeletal and connective tissue disorders occurred in one patient, an 80-year-old female from the NDD-CKD nephrology treatment group. The osteoporotic fracture was reported by the treating physician and was not positively adjudicated as HP; it is to be noted that patients with CKD are prone to fractures due to renal osteodystrophy, which is itself caused by disturbances in metabolic and hormone levels such as parathyroid hormone and vitamin D [51,52]. In our pooled analysis, reported symptomatic HP was rare.…”

Perioperative Care and Airway Management for a Patient With Sagliker Syndrome

“…SS is a rare but devastating condition in a subset of patients with ESRD. Likely a severe form of renal osteodystrophy [ 12 ], SS is characterized by a distinct constellation of anatomical and physiological features as seen in our patient [ 1 - 3 , 13 ]. Given her comorbidities, perioperative coordination facilitated by the PAS team was an essential part of her care plan.…”

A retrospective study of hemodialysis treated end-stage renal disease patients with renal osteodystrophy-associated fragility fractures

“…Due to the advanced stage of chronic renal disease, renal osteodystrophy often occurs in ESRD patients, and subsequent fractures are common. Renal osteodystrophy usually interferes with bone metabolism and related hormone levels to reduce bone mass, strength and cause abnormal bone remodeling (7,8). These bone abnormalities are common in most ESRD patients, especially those requiring dialysis (9).…”