Background theses for the formulation of guidelines on diagnosis and therapy metabolic bone disease as a part of CKD-MBD, with specific focus on low mineral bone content in DXA examination
Authors:
V. Palička 1; S. Dusilová Sulková 2,3; L. Brunerová 4
Authors‘ workplace:
Osteocentrum, Ústav klinické biochemie a diagnostiky LF UK a FN Hradec Králové
1; Hemodialyzační středisko FN Hradec Králové
2; Katedra interních oborů LF UK, Hradec Králové
3; II. interní klinika FNKV a 3. LF UK, Praha
4
Published in:
Klin. Biochem. Metab., 28, 2020, No. 2, p. 64-72
Overview
The paper brings the basal background for the interdisciplinary cooperation between clinical osteology and nephrology in the field of metabolic osteopathy in kidney patients. Traditionally, renal bone disease is presented as a result of missing excretory, as well as endocrine renal function. Its main cause is secondary hyperparathyroidism, resp. disordered function of parathyroid glands. The term CKD-MBD, promoted in 2006, take into account the association between bone disorder and its systemic consequences, namely cardiovascular. The indication for the DXA assessment in kidney patients is growing. Low bone mineral content, however, is not representative for the severity of hyperparathyreosis, but it brings important information about associated or even dominating osteoporosis. It has been proven that renal patients may suffer from any other metabolic disease, not being associated with renal function. Clinical osteology focused on metabolic bone diseases. The most common bone disease is osteoporosis. As stated above, this osteoporosis may be modifying or even dominating finding also in patients with chronic kidney disease and even renal failure. The associa-tion with growing age of dialysis patients, with more common hormonal and nutritional disorders, long-lasting vitamin D deficiency, but also with the increasing frequencies of corticosteroid treatments, can be associated with the low bone mineral content in these patients. Low bone mineral content in DXA assessment is diagnostics for osteoporosis. Therapy of osteoporosis in physiological renal function follows its rules. However, osteoporosis itself, i.e. low bone mineral density, we found also in patients with chronic kidney disease and even in patients with kidney failure. In these patients, there is no necessary the link to traditional causes of renal osteodystrophy. Therapy of renal bone disease associated with functional derangement of parathyroid glands in kidney patients is well known. The same is true for the diagnosis and treatment of osteoporosis in basic population. However, practical recommendations for the treatment osteoporotic component, resp. renal osteopathy with low bone mineral content, are still lacking. The aim of this paper is to formulate the background for the wide discussion of experts. This should lead to formulation of concrete and practical recommendations for the treatment of osteoporosis (defined as osteopathy with DXA proven low bone mineral density) in patients with chronic renal disease as well as renal failure.
Keywords:
osteoporosis – bisphosphonates – dialysis – antiosteoresorptive therapy – chronic renal disease (CKD) – denosumab – densitometry (DXA) – low bone mineral content – renal osteodystrophy – secondary hyperparathyroidism
Sources
1. Cunningham, J., Locatelli, F., Rodriquez, M. Secon-dary hyperparathyoidism: pathogenesis, disease progression and therapeutic options. Clin. J Am. Soc. Nephrol., 2011, 6(4): p. 913–921. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.06040710>.
2. Hruska, K. A., Teitelbaum, S. L. Renal Osteodystrophy. N Engl. J Med., 1995, 333(3): p. 166–174. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJM199507203330307>.
3. Moe, S. M., Drueke, T. B. et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006, 69(11): p. 1945–1953. Dostupné z DOI: <http://dx.doi.org/10.1038/sj.ki.5000414>.
4. Cunningham, J., Sprague, S. M., Cannata-Andia, J. et al. [Osteoporosis Work Group]. Osteoporosis in chronic kidney disease. Am J Kidney Dis. 2004, 43(3): p. 556–571. Dostupné z DOI: <http://dx.doi.org/10.1053/j.ajkd.2003.12.004>. Komentář in: Dusilová-Sulková, S. Osteoporóza a selhání ledvin. Postgrad. Nefrol., 2004, 2(4): p. 50–51.
5. Štěpánková, J., Brunová, J. Léčba osteoporózy u dia-lyzovaných pacientů. Postgrad. Nefrol., 2019, 17(4): p. 7–9.
6. Moe, S. M. Renal Osteodystrophy or Kidney-Induced Osteoporosis? Curr Osteoporos. Rep., 2017, 15(3): p. 194–197. Dostupné z DOI: <http://dx.doi.org/10.1007/s11914–017–0364–1>.
7. Miller, P. D. Bone disease in CKD: a focus on osteoporosis diagnosis and management. Am J Kidney Dis., 2014, 64(2): p. 290–304. Dostupné z DOI: <http://dx.doi.org/10.1053/j.ajkd.2013.12.018>.
8. Brunerová, L., Palička, V., Dusilova-Sulkova, S. Commentary on management of osteoporosis in advanced CKD: common view of a nephrologist and bone specialist. Endocrine Practice, 2019, 25 (2): p. 193–196. Dostupné z DOI: <https://doi.org/10.4158/EP-2018–0311>.
9. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group]. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl. 2009, (113): S1-S130. Dostupné z DOI: <http://dx.doi.org/10.1038/ki.2009.188>.
10. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int., 2017, 7(1): p. 1–59. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kisu.2017.04.001>. Erratum in Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 2017, 7: p. 1–59. Dostupné z WWW: <http://www.kisupplements.org>.
11. Festuccia, F., Jafari, M. T., Moioli, A. et al. Safety and efficacy of denosumab in osteoporotic hemodialysed patients. J Nephrol., 2017, 30(2): p. 271–279. Dostupné z DOI: <http://dx.doi.org/10.1007/s40620–016–0334–1>.
12. Ritter, C. S., Slatopolsky, E. Phosphate toxicity in CKD: the killer among us. Clin. J Am. Soc. Nephrol., 2016, 11(6): p. 1088–1100. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.11901115>.
13. Nitta, K., Yajima, A., Tsuchiya, K. Management of Osteoporosis in Chronic Kidney Disease. Intern. Med., 2017, 56(24): p. 3271–3276. Dostupné z DOI: <http://dx.doi.org/10.2169/internalmedicine.8618–16>.
14. Bergner, R. Bisphosphonate therapy in renal osteodystrophy – a review. J Nephrol. 2013, 26(3): p. 450–455. Dostupné z DOI: <http://dx.doi.org/10.5301/jn.5000188>.
15. Brunerová, L., Ronová, P., Verešová, J. et al. Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients. Kidney Blood Press Res., 2016, 41(3): p. 345–354. Dostupné z DOI: <http://dx.doi.org/10.1159/000443439>.
16. Aleksova, J., Kurniawan, S., Elder, G. J. The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease. Osteoporos. Int. 2018, 29(6): p. 1447–1455. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198–018–4468-y>.
17. Bouquegneau, A., Salam, S., Delanaye, P. et al. Bone disease after kidney transplantation. Clin. J Am. Soc. Nephrol., 2016, 11(7): p. 1282–1296. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.11371015>.
18. Nakai, K., Fujii, H., Ishimura, T. et al. Incidence and Risk Factors of Persistent Hyperparathyroidism After Kidney Transplantation. Transplant. Proc., 2017, 49(1): p. 53–56. Dostupné z DOI: <http://dx.doi.org/10.1016/j.transproceed.2016.10.011>.
19. Brunova, J., Kratochvilova, S., Stepankova, J. Osteoporosis Therapy with Denosumab in Organ Transplant Recipients. Front Endocrinol. (Lausanne) 2018, 9: 162. Dostupné z DOI: <http://dx.doi.org/10.3389/fendo.2018.00162>.
20. Kan, S. L., Ning, G. Z., Chen, L. X. et al. Efficacy and Safety of Bisphosphonates for Low Bone Mineral Density After Kidney Transplantation: A Meta-Analysis. Medicine (Baltimore) 2016; 95(5): e2679. Dostupné z DOI: <http://dx.doi.org/10.1097/MD.0000000000002679>.
21. Pimentel, A., Ureña-Torres, P., Zillikens, M. C. et al. Fractures in patients with CKD-diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation. Kidney Int., 2017, 92(6): p. 1343–1355. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kint.2017.07.021>.
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Clinical biochemistry Nuclear medicine Nutritive therapistArticle was published in
Clinical Biochemistry and Metabolism
2020 Issue 2
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