Kidney-induced osteoporosis: a new entity with a novel therapeutic approach

• Published in: Portuguese journal of nephrology & hypertension Vol. 34; no. 2; pp. 92 - 100
• Main Authors: Pereira, Ana, Frazão, João
• Format: Journal Article
• Language: English; Portuguese
• Published: Sociedade Portuguesa de Nefrologia 14.07.2020
• Subjects: UROLOGY & NEPHROLOGY; romosozumab; teriparatide; osteoporosis; renal osteodystrophy; denosumab; chronic kidney disease-mineral bone disease
• ISSN: 0872-0169; 2183-1289
• DOI: 10.32932/pjnh.2020.07.073

Over the past century, important scientific advances have been made regarding the complex pathophysiology of bone disease in renal patients. Bone disease in renal patients is included in a wider spectrum of disease, the CKD-mineral bone disorders (CKD-MBD). Older patients with CKD can present with both age-related osteoporosis and renal osteodystrophy. Clinicians are now challenged with the need to prevent fracture in these CKD patients, where the efficacy and safety of pharmacologic agents used for the general osteoporotic population have not been studied. Treatment of renal osteodystrophy has been focused on control of the parathyroid secretion with calcitriol, vitamin D analogs and calcimimetic agents. However, there is an increase in fractures with aging in patients with CKD, suggesting that these patients also have the fracture risk factors common to the general population, such as age. Pharmacologic agents, such as teriparatide, denosumab and romosozumab have been developed for osteoporosis treatment with a direct effect on bone cell activity, osteoblasts and osteoclasts. This article reviews the derangements in bone turnover, mineralization and volume in CKD-MBD. In addition, we will also discuss strategies to manage osteoporosis in CKD and the available data on the new pharmacological agents in CKD-patients.