CKD & Bone Health: New Management Guidelines

In a consensus statement issued by the European Renal Association and published online Nov. 28 in Nephrology Dialysis Transplantationrecommendations are presented for the management of skeletal fragility in patients with chronic kidney disease (CKD).

Maria Fusaro, M.D., Ph.D., from the Institute of Clinical Physiology in Pisa, Italy, and colleagues discussed the management of skeletal frailty in patients with CKD, focusing on vertebral fractures (VFs) in CKD stages G4 to G5D.

The authors note that VFs are a common complication in patients with CKD, affecting up to 50% of patients; they are associated with higher mortality in patients predialysis and those receiving dialysis. In patients with advanced CKD, regular (every 12 months) thoracolumbar lateral X-rays are recommended for diagnosing VFs and abdominal aortic calcification.

For patients considered at high risk for fracture, dual-energy X-ray absorptiometry scans should be performed routinely and be repeated every 12 to 24 months to monitor the impact of therapy. Routine monitoring of mineral metabolism parameters is recommended, and therapy should be optimized for hyperparathyroidism, hyperphosphatemia, and hypocalcemia to lower VF risk.

Monitoring non-kidney-retained bone turnover markers such as bone-specific alkaline phosphatase, intact procollagen type I N-propeptide and tartrate-resistant acid phosphatase 5b should be prioritized in patients with CKD. A fracture liaison servicewhich establishes a multidisciplinary team, is a fundamental requirement of osteoporosis care, according to the authors.

“By translating complex research into practical recommendations, the authors are making a direct contribution to better patient care and improved long-term outcomes,” co-author Eugene Mc Closkey, M.D., from the University of Sheffield in the United Kingdom, said in a statement.

Several authors disclosed ties to the biopharmaceutical and medical technology industries.

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