Bone and Kidney Disease: Diagnostic and Therapeutic Implications

• Published in: Current rheumatology reports Vol. 14; no. 3; pp. 217 - 223
• Main Authors: Jamal, Sophie A., West, Sarah L., Miller, Paul D.
• Format: Journal Article
• Language: English
• Published: New York Current Science Inc 01.06.2012
• Subjects: Bone Density Conservation Agents - therapeutic use; Bone Diseases, Metabolic - diagnosis; Bone Diseases, Metabolic - drug therapy; Bone Diseases, Metabolic - etiology; Humans; Medicine; Medicine & Public Health; Osteoporosis - diagnosis; Osteoporosis - drug therapy; Osteoporosis - etiology; Osteoporosis and Metabolic Bone Disease (Kg Saag; Renal Insufficiency, Chronic - complications; Rheumatology; Section Editor; Severity of Illness Index; Osteoporosis; Fractures; Treatment; Diagnostic; Therapeutic; Chronic kidney disease; Bone disease; Bone mineral density
• ISSN: 1523-3774; 1534-6307
• DOI: 10.1007/s11926-012-0243-9

Fractures are common in patients with chronic kidney disease (CKD), but the diagnosis and treatment of bone disease in CKD are difficult due to the multiple etiologies of bone disease in these patients. Noninvasive imaging, including bone mineral density by dual energy x-ray absorptiometry, can be useful in diagnosing osteoporosis in predialysis CKD; however, consensus on the diagnosis of osteoporosis among those with advanced CKD—particularly stage 5 CKD patients on dialysis—is lacking. Treatments approved for osteoporosis in postmenopausal women may be used in patients with stage 1 to 3 CKD. Furthermore, post-hoc analyses show efficacy and safety of oral bisphosphonates, raloxifene, and denosumab in stage 4 CKD for short-term treatment. However, treatment decisions are more difficult in stage 5 CKD. Bone biopsy may be required, and most treatments, if used, would be off label. Overall, the diagnosis and treatment of bone disease in patients with CKD require further research.