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

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 association 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