Multidisciplinary team approach for CKD-associated osteoporosis

Ditte Hansen; Hanne Mari Skou Jørgensen; Thomas Levin Andersen; Ana Carina Ferreira; Anibal Ferreira; Renate de Jongh; Satu Keronen; Heikki Kröger; Marie-Helene Lafage-Proust; Leena Martola; Kenneth Poole; Xiaoyu  Tong; Pieter Evenepoel; Mathias Haarhaus

doi:10.1093/ndt/gfae197

Multidisciplinary team approach for CKD-associated osteoporosis

Ditte Hansen, Hanne Mari Skou Jørgensen, Thomas Levin Andersen, Ana Carina Ferreira, Anibal Ferreira, Renate de Jongh, Satu Keronen, Heikki Kröger, Marie-Helene Lafage-Proust, Leena Martola, Kenneth Poole, Xiaoyu Tong, Pieter Evenepoel, Mathias Haarhaus

Department of Clinical Medicine - Department of Medicine and Nephrology

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

2 Citations (Scopus)

Abstract

Chronic kidney disease-mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected four representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKD G5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.

Original language	English
Journal	Nephrology Dialysis Transplantation
Volume	40
Issue	1
Pages (from-to)	48-59
Number of pages	12
ISSN	0931-0509
DOIs	https://doi.org/10.1093/ndt/gfae197
Publication status	Published - 1 Jan 2025

Keywords

bone biopsy
chronic kidney disease–mineral and bone disorder
multidisciplinary team
osteoporosis
renal osteodystrophy

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10.1093/ndt/gfae197

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Hansen, D., Jørgensen, H. M. S., Levin Andersen, T., Ferreira, A. C., Ferreira, A., de Jongh, R., Keronen, S., Kröger, H., Lafage-Proust, M.-H., Martola, L., Poole, K., Tong, X., Evenepoel, P., & Haarhaus, M. (2025). Multidisciplinary team approach for CKD-associated osteoporosis. Nephrology Dialysis Transplantation, 40(1), 48-59. https://doi.org/10.1093/ndt/gfae197

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abstract = "Chronic kidney disease-mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected four representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKD G5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.",

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AU - Keronen, Satu

AU - Kröger, Heikki

AU - Lafage-Proust, Marie-Helene

AU - Martola, Leena

AU - Poole, Kenneth

AU - Tong, Xiaoyu

AU - Evenepoel, Pieter

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JO - Nephrology Dialysis Transplantation

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Multidisciplinary team approach for CKD-associated osteoporosis

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Keywords

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