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Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review
Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fractur...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555655/ https://www.ncbi.nlm.nih.gov/pubmed/32961953 http://dx.doi.org/10.3390/ijms21186846 |
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author | Hsu, Chia-Yu Chen, Li-Ru Chen, Kuo-Hu |
author_facet | Hsu, Chia-Yu Chen, Li-Ru Chen, Kuo-Hu |
author_sort | Hsu, Chia-Yu |
collection | PubMed |
description | Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD. |
format | Online Article Text |
id | pubmed-7555655 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-75556552020-10-19 Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review Hsu, Chia-Yu Chen, Li-Ru Chen, Kuo-Hu Int J Mol Sci Review Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD. MDPI 2020-09-18 /pmc/articles/PMC7555655/ /pubmed/32961953 http://dx.doi.org/10.3390/ijms21186846 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Hsu, Chia-Yu Chen, Li-Ru Chen, Kuo-Hu Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review |
title | Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review |
title_full | Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review |
title_fullStr | Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review |
title_full_unstemmed | Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review |
title_short | Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review |
title_sort | osteoporosis in patients with chronic kidney diseases: a systemic review |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555655/ https://www.ncbi.nlm.nih.gov/pubmed/32961953 http://dx.doi.org/10.3390/ijms21186846 |
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