Navigating Bone Health in Chronic Kidney Disease: A Comprehensive Review of CKD-MBD and Osteoporosis

Abstract
Chronic kidney disease (CKD) is a common and progressive disorder associated with significant alterations in bone morphology and mineral metabolism, leading to a complex syndrome known as CKDmineral and bone disorder (CKD-MBD). This condition involves biochemical, skeletal, and vascular abnormalities, all of which have been independently related to cardiovascular events and elevated mortality. Renal osteodystrophy (ROD) is bone component and related with increased fracture risk. Reduced bone quality and low bone mass in osteoporosis induce fragility fractures, and both ROD and osteoporosis independently contribute to higher fragility fracture risk, particularly in older individuals, posing diagnostic and management challenges due to the interplay between traditional osteoporosis and CKD-specific bone disorders.

This review summarizes the pathophysiology, diagnostic challenges, and management approaches for osteoporosis and CKD-MBD. It emphasizes the importance of distinguishing osteoporosis from other elements of CKD-MBD to accurately assess fracture risk and optimize treatment. The complexity of these conditions necessitates a nuanced approach that considers both CKD-specific and traditional risk factors. Advances in diagnostic tools, including biomarkers and imaging techniques, have improved the evaluation of bone health in CKD; nevertheless, some limitations and caveats should be considered. Pharmacological agents such as bisphosphonates, denosumab, and anabolic agents have demonstrated varying efficacy and safety profiles across different CKD stages.

Overall, managing bone health in CKD requires personalized treatment strategies to address both osteoporosis and CKD-MBD. Continued research is essential to refine diagnostic approaches and develop targeted therapies that minimize fracture risk and improve clinical outcomes in this high-risk population.

Cite this article as: Turhan Iyidir O. Navigating bone health in chronic kidney disease: A comprehensive review of CKD-MBD and osteoporosis. Endocrinol Res Pract. Published online November 4, 2024. doi 10.5152/erp.2024.24514.