Management of fracture risk in CKD – traditional and novel approaches

Matthias Haarhaus; Louise Aaltonen; Daniel Cejka; Mario Cozzolino; Renate de Jong; Patrick C. D'Haese; Pieter Evenepoel; Marie-Helene Lafage-Proust; Sandro Mazzaferro; Eugene McCloskey; Syazrah Salam; Hanne Mari Skou Jørgensen; Marc Vervloet; CKD-MBD Working Group of the ERA

doi:10.1093/ckj/sfac230

Management of fracture risk in CKD – traditional and novel approaches

Matthias Haarhaus^*, Louise Aaltonen, Daniel Cejka, Mario Cozzolino, Renate de Jong, Patrick C. D'Haese, Pieter Evenepoel, Marie-Helene Lafage-Proust, Sandro Mazzaferro, Eugene McCloskey, Syazrah Salam, Hanne Mari Skou Jørgensen, Marc Vervloet, CKD-MBD Working Group of the ERA

^*Corresponding author for this work

Department of Clinical Medicine - Department of Medicine and Nephrology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

24 Citations (Scopus)

Abstract

The coexistence of osteoporosis and chronic kidney disease (CKD) is an evolving health care challenge in the face of increasingly aging populations. Globally, accelerating fracture incidence causes disability, impaired quality of life, and increased mortality. Consequently, several novel diagnostic and therapeutic tools have been introduced for treatment and prevention of fragility fractures. Despite an especially high fracture risk in CKD, these patients are commonly excluded from interventional trials and clinical guidelines. While management of fracture risk in CKD has been discussed in recent opinion-based reviews and consensus papers in the nephrology literature, many patients with CKD stages 3–5D and osteoporosis are still underdiagnosed and untreated. The current review addresses this potential treatment nihilism by discussing established and novel approaches to diagnosis and prevention of fracture risk in patients with CKD stages 3–5D. Skeletal disorders are common in CKD. A wide variety of underlying pathophysiological processes have been identified, including premature aging, chronic wasting, and disturbances in vitamin D and mineral metabolism, which may impact bone fragility beyond established osteoporosis. We discuss current and emerging concepts of CKD—mineral and bone disorders (CKD-MBD) and integrate management of osteoporosis in CKD with current recommendations for management of CKD-MBD. While many diagnostic and therapeutic approaches to osteoporosis can be applied to patients with CKD, some limitations and caveats need to be considered. Consequently, clinical trials are needed that specifically study fracture prevention strategies in patients with CKD stages 3–5D.

Original language	English
Article number	sfac230
Journal	Clinical Kidney Journal
Volume	16
Issue	3
Pages (from-to)	456-472
Number of pages	17
ISSN	2048-8505
DOIs	https://doi.org/10.1093/ckj/sfac230
Publication status	Published - 1 Mar 2023

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Haarhaus, M., Aaltonen, L., Cejka, D., Cozzolino, M., de Jong, R., D'Haese, P. C., Evenepoel, P., Lafage-Proust, M.-H., Mazzaferro, S., McCloskey, E., Salam, S., Jørgensen, H. M. S., Vervloet, M., & CKD-MBD Working Group of the ERA (2023). Management of fracture risk in CKD – traditional and novel approaches. Clinical Kidney Journal, 16(3), 456-472. Article sfac230. https://doi.org/10.1093/ckj/sfac230

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abstract = "The coexistence of osteoporosis and chronic kidney disease (CKD) is an evolving health care challenge in the face of increasingly aging populations. Globally, accelerating fracture incidence causes disability, impaired quality of life, and increased mortality. Consequently, several novel diagnostic and therapeutic tools have been introduced for treatment and prevention of fragility fractures. Despite an especially high fracture risk in CKD, these patients are commonly excluded from interventional trials and clinical guidelines. While management of fracture risk in CKD has been discussed in recent opinion-based reviews and consensus papers in the nephrology literature, many patients with CKD stages 3–5D and osteoporosis are still underdiagnosed and untreated. The current review addresses this potential treatment nihilism by discussing established and novel approaches to diagnosis and prevention of fracture risk in patients with CKD stages 3–5D. Skeletal disorders are common in CKD. A wide variety of underlying pathophysiological processes have been identified, including premature aging, chronic wasting, and disturbances in vitamin D and mineral metabolism, which may impact bone fragility beyond established osteoporosis. We discuss current and emerging concepts of CKD—mineral and bone disorders (CKD-MBD) and integrate management of osteoporosis in CKD with current recommendations for management of CKD-MBD. While many diagnostic and therapeutic approaches to osteoporosis can be applied to patients with CKD, some limitations and caveats need to be considered. Consequently, clinical trials are needed that specifically study fracture prevention strategies in patients with CKD stages 3–5D.",

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Haarhaus, M, Aaltonen, L, Cejka, D, Cozzolino, M, de Jong, R, D'Haese, PC, Evenepoel, P, Lafage-Proust, M-H, Mazzaferro, S, McCloskey, E, Salam, S, Jørgensen, HMS, Vervloet, M & CKD-MBD Working Group of the ERA 2023, 'Management of fracture risk in CKD – traditional and novel approaches', Clinical Kidney Journal, vol. 16, no. 3, sfac230, pp. 456-472. https://doi.org/10.1093/ckj/sfac230

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AU - Haarhaus, Matthias

AU - Aaltonen, Louise

AU - Cejka, Daniel

AU - Cozzolino, Mario

AU - de Jong, Renate

AU - D'Haese, Patrick C.

AU - Evenepoel, Pieter

AU - Lafage-Proust, Marie-Helene

AU - Mazzaferro, Sandro

AU - McCloskey, Eugene

AU - Salam, Syazrah

AU - Jørgensen, Hanne Mari Skou

AU - Vervloet, Marc

AU - CKD-MBD Working Group of the ERA

PY - 2023/3/1

Y1 - 2023/3/1

N2 - The coexistence of osteoporosis and chronic kidney disease (CKD) is an evolving health care challenge in the face of increasingly aging populations. Globally, accelerating fracture incidence causes disability, impaired quality of life, and increased mortality. Consequently, several novel diagnostic and therapeutic tools have been introduced for treatment and prevention of fragility fractures. Despite an especially high fracture risk in CKD, these patients are commonly excluded from interventional trials and clinical guidelines. While management of fracture risk in CKD has been discussed in recent opinion-based reviews and consensus papers in the nephrology literature, many patients with CKD stages 3–5D and osteoporosis are still underdiagnosed and untreated. The current review addresses this potential treatment nihilism by discussing established and novel approaches to diagnosis and prevention of fracture risk in patients with CKD stages 3–5D. Skeletal disorders are common in CKD. A wide variety of underlying pathophysiological processes have been identified, including premature aging, chronic wasting, and disturbances in vitamin D and mineral metabolism, which may impact bone fragility beyond established osteoporosis. We discuss current and emerging concepts of CKD—mineral and bone disorders (CKD-MBD) and integrate management of osteoporosis in CKD with current recommendations for management of CKD-MBD. While many diagnostic and therapeutic approaches to osteoporosis can be applied to patients with CKD, some limitations and caveats need to be considered. Consequently, clinical trials are needed that specifically study fracture prevention strategies in patients with CKD stages 3–5D.

AB - The coexistence of osteoporosis and chronic kidney disease (CKD) is an evolving health care challenge in the face of increasingly aging populations. Globally, accelerating fracture incidence causes disability, impaired quality of life, and increased mortality. Consequently, several novel diagnostic and therapeutic tools have been introduced for treatment and prevention of fragility fractures. Despite an especially high fracture risk in CKD, these patients are commonly excluded from interventional trials and clinical guidelines. While management of fracture risk in CKD has been discussed in recent opinion-based reviews and consensus papers in the nephrology literature, many patients with CKD stages 3–5D and osteoporosis are still underdiagnosed and untreated. The current review addresses this potential treatment nihilism by discussing established and novel approaches to diagnosis and prevention of fracture risk in patients with CKD stages 3–5D. Skeletal disorders are common in CKD. A wide variety of underlying pathophysiological processes have been identified, including premature aging, chronic wasting, and disturbances in vitamin D and mineral metabolism, which may impact bone fragility beyond established osteoporosis. We discuss current and emerging concepts of CKD—mineral and bone disorders (CKD-MBD) and integrate management of osteoporosis in CKD with current recommendations for management of CKD-MBD. While many diagnostic and therapeutic approaches to osteoporosis can be applied to patients with CKD, some limitations and caveats need to be considered. Consequently, clinical trials are needed that specifically study fracture prevention strategies in patients with CKD stages 3–5D.

KW - biomarkers

KW - bone mineral density

KW - calcium

KW - cinacalcet

KW - mineral metabolism

KW - parathyroidectomy

KW - renal osteodystrophy

KW - vitamin D

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JF - Clinical Kidney Journal

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M1 - sfac230

ER -

Management of fracture risk in CKD – traditional and novel approaches

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