Understanding Bone Disease in Patients with Diabetic Kidney Disease: a Narrative Review
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BONE AND DIABETES (A SCHWARTZ AND P VESTERGAARD, SECTION EDITORS)
Understanding Bone Disease in Patients with Diabetic Kidney Disease: a Narrative Review Sabina Chaudhary Hauge 1
&
Morten Frost 2 & Ditte Hansen 1,3
Accepted: 29 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Both diabetes and kidney disease associate with the development of bone disease and an increased risk of fragility fractures. The etiologies of bone disease in patients with diabetic kidney disease (DKD) are multiple and complex. This review explores the association between DKD and bone disease and discusses how the presence of both diabetes and kidney disease may impair bone quality and increase fracture risk. Diagnostic tools as well as future research areas are also discussed. Recent Findings Patients with DKD have an increased risk of fragility fracture, most pronounced in patients with type 1 diabetes, and in DKD a high prevalence of adynamic bone disease is found. Recent studies have demonstrated disturbances in the interplay between bone regulating factors in DKD, such as relative hypoparathyroidism and alterations of bone-derived hormones including fibroblast growth factor-23 (FGF-23), sclerostin and klotho, which lead to bone disease. Summary This review examines the current knowledge on bone disease in patients with DKD, clinical considerations for patient care, as well as subjects for future research. Keywords Diabetes mellitus . Chronic kidney disease . Bone . Fracture . Adynamic bone disease
Introduction With longer life expectancies, the number of patients with chronic kidney disease (CKD) is predicted to increase. Diabetes mellitus is one of the major contributors to CKD in developed countries, and the rise in the prevalence of diabetes (mainly type 2 diabetes (T2D)) is expected to increase the number of patients with diabetic kidney disease (DKD) [1]. Additionally, patients with CKD due to other causes have increased risk of developing diabetes [2]. As such, CKD and diabetes often coexist, and 25% of patients with end-stage kidney disease have diabetes [3]. DKD associates with several
This article is part of the Topical Collection on Bone and Diabetes
concomitant diseases, including bone disease and fragility fractures, indicating that the number of DKD-related fragility fractures may increase substantially in the future. New mechanisms, which influence on the development of bone disease in patients with DKD, have been discovered, uncovering new treatment targets and changing clinical management of this condition. Current knowledge on bone disease in patients with DKD is primarily based on data from interventional and observational trials in animal models or patients with either diabetes or CKD. This review first considers studies of diabetes and bone disease, then CKD and bone disease, and finally, the knowledge from the limited available studies in patients with both diabetes and CKD (i.e., DKD) and bone disease is summarized. Figure 1 summarizes the discus
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