Diagnosis and management of osteoporosis in chronic kidney disease stages 4 to 5D: a call for a shift from nihilism to pragmatism

• Published in: Osteoporosis international Vol. 32; no. 12; pp. 2397 - 2405
• Main Authors: Evenepoel, P., Cunningham, J., Ferrari, S., Haarhaus, M., Javaid, M.K., Lafage-Proust, M.-H., Prieto-Alhambra, D., Torres, P.U., Cannata-Andia, J.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.12.2021; Springer Nature B.V
• Subjects: Bone diseases; Diagnosis; Dialysis; Disease management; Endocrinology; Fractures; Kidney diseases; Kidney transplantation; Medical diagnosis; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Minerals; Orthopedics; Osteoporosis; Patients; Review; Rheumatology; Risk assessment; Risk factors; Osteoporosis; Chronic kidney disease
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-021-05975-7

The European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) CKD-MBD working group, in collaboration with the Committee of Scientific Advisors of the International Osteoporosis Foundation, published a position paper for the diagnosis and management of osteoporosis in patients with CKD stages 4–5D (eGFR < 30 ml/min 1.73 m 2 ). The present article reports and summarizes the main recommendations included in this 2021 document. The following areas are reviewed: diagnosis of osteoporosis; risk factors for fragility fractures; fracture risk assessment; intervention thresholds for pharmacological intervention; general and pharmacological management of osteoporosis; monitoring of treatment, and systems of care, all in patients with CKD stages 4–5D. Guidance is provided for clinicians caring for CKD stages 4–5D patients with osteoporosis, allowing for a pragmatic individualized diagnostic and therapeutic approach as an alternative to current variations in care and treatment nihilism.