Bone Fragility Fractures in CKD Patients
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REVIEW
Bone Fragility Fractures in CKD Patients Ana Pimentel1 · Pablo Ureña‑Torres1,2 · Jordi Bover3 · Jose Luis Fernandez‑Martín4 · Martine Cohen‑Solal5 Received: 8 October 2020 / Accepted: 4 November 2020 © The Author(s) 2020
Abstract Chronic kidney diseases (CKD) are associated with mineral and bone diseases (MBD), including pain, bone loss, and fractures. Bone fragility related to CKD includes the risk factors observed in osteoporosis in addition to those related to CKD, resulting in a higher risk of mortality related to fractures. Unawareness of such complications led to a poor management of fractures and a lack of preventive approaches. The current guidelines of the Kidney Disease Improving Global Outcomes (KDIGO) recommend the assessment of bone mineral density if results will impact treatment decision. In addition to bone density, circulating biomarkers of mineral, serum bone turnover markers, and imaging techniques are currently available to evaluate the fracture risk. The purpose of this review is to provide an overview of the epidemiology and pathogenesis of CKD-associated bone loss. The contribution of the current tools and other techniques in development are discussed. We here propose a current view of how to better predict bone fragility and the therapeutic options in CKD. Keywords Bone · Fracture · Bone mineral density · CKD-MBD · Phosphate · Calcium · Parathyroid hormone · Imaging
Introduction The high morbidity and mortality rates observed in progressive chronic kidney disease (CKD) are tightly associated to the underlying metabolic bone alterations. The mineral and bone disorders (MBD) associated with CKD include bone, biochemical, and cardiovascular abnormalities in the same entity since they share common pathophysiological mechanisms. This current new definition of CKD-MBD aims at a better awareness of concommitant bone and cardiovascular events and shows that common molecules are
* Martine Cohen‑Solal martine.cohen‑[email protected] 1
AURA Paris-Nord, Saint‑Ouen, France
2
Necker Hospital, University of Paris Descartes, Department of Renal Physiology, Paris, France
3
Fundació Puigvert, Universitat Autònoma, IIB Sant Pau, REDinREN, Nephrology Department, Barcelona, Catalonia, Spain
4
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN del ISCIII, Hospital Universitario Central de Asturias. Universidad de Oviedo, Bone and Mineral Research Unit, Oviedo, Asturias, Spain
5
INSERM U1132 & Université de Paris, Hôpital Lariboisière, Department of Rheumatology, Paris, France
involved in both tissues breakdown. The initial characterization of previously called renal osteodystrophy (ROD) was based on bone biopsy and is extended nowadays to bone markers of fragility, including biochemistry and imaging. Bone fragility includes all the aspects that lead to fractures, particularly bone volume, structure, rate of remodeling, as well as mineralization defects which can be also observed in CKD. Fractures are the end results of skeletal fragility, the prev
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