Bone Quality in CKD Patients: Current Concepts and Future Directions – Part I

• Published in: Kidney diseases Vol. 7; no. 4; pp. 268 - 277
• Main Authors: Asadipooya, Kamyar, Abdalbary, Mohamed, Ahmad, Yahya, Kakani, Elijah, Monier-Faugere, Marie-Claude, El-Husseini, Amr
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.07.2021; Karger Publishers
• Subjects: bone mineral density; bone quality; Bones; chronic kidney disease; Chronic kidney failure; Density; Medical research; Medicine, Experimental; Osteoporosis; Quality management; Review; Review Article; Tetracycline; Tetracyclines; Bone quality; Chronic kidney disease; Bone mineral density
• ISSN: 2296-9381; 2296-9357
• DOI: 10.1159/000515534

Background: There is ample evidence that patients with CKD have an increased risk of osteoporotic fractures. Bone fragility is not only influenced by low bone volume and mass but also by poor microarchitecture and tissue quality. More emphasis has been given to the quantitative rather than qualitative assessment of bone health, both in general population and CKD patients. Although bone mineral density (BMD) is a very useful clinical tool in assessing bone strength, it may underestimate the fracture risk in CKD patients. Serum and urinary bone biomarkers have been found to be reflective of bone activities and predictive of fractures independently of BMD in CKD patients. Bone quality and fracture risk in CKD patients can be better assessed by utilizing new technologies such as trabecular bone score and high-resolution imaging studies. Additionally, invasive assessments such as bone histology and micro-indentation are useful counterparts in the evaluation of bone quality. Summary: A precise diagnosis of the underlying skeletal abnormalities in CKD patients is crucial to prevent further bone loss and fractures. We must consider bone quantity and quality abnormalities for management of CKD patients. Here in this part I, we are focusing on advances in bone quality diagnostics that are expected to help in proper understanding of the bone health in CKD patients. Key Messages: Assessment of bone quality and quantity in CKD patients is essential. Both noninvasive and invasive techniques for the assessment of bone quality are available.