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Advances in renal bone disease: Osteoporosis and chronic kidney disease

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Abstract

Osteoporosis is a common bone disease characterized by low bone density, microarchitectural deterioration of bone tissue, and a consequent increase in fracture risk. Recent decades have seen major advances in the understanding of the pathophysiology, prevention, and treatment of this disorder. Chronic kidney disease (CKD) affects more than 20 million Americans and is associated with unique metabolic mineral disorders related to low bone density and increased fractures. Because many patients with low bone density may have CKD, and the combination of osteoporosis and CKD may further increase fracture risk with increased morbidity and mortality, appropriate identification is necessary for effective management. The clinical, laboratory, and imaging studies currently used to diagnose osteoporosis in the general population inadequately detect the complex bone and metabolic changes that occur with CKD. This review focuses on the pathophysiology of osteoporosis and CKD and discusses problems with current diagnostic tools and considerations for treatment regimens.

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References and Recommended Reading

  1. Gabriel SE, Tosteson AN, Leibson CL, et al.: Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 2002, 13:323–330.

    Article  PubMed  CAS  Google Scholar 

  2. Moe S, Drüeke T, Cunningham J, et al.: Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006, 69:1945–1953.

    Article  PubMed  CAS  Google Scholar 

  3. Stehman-Breen CO, Sherrard DJ, Alem AM, et al.: Risk factors for hip fractures among patients with end-stage renal disease. Kidney Int 2000, 58:2200–2205.

    Article  PubMed  CAS  Google Scholar 

  4. Coco M, Rush H: Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 2000, 36:1115–1121.

    Article  PubMed  CAS  Google Scholar 

  5. Atsumi K, Kushida K, Yamazaki K, et al.: Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 1999, 33:287–293.

    Article  PubMed  CAS  Google Scholar 

  6. Jamal SA, Hayden JA, Beyene J: Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis 2007, 49:674–681.

    Article  PubMed  Google Scholar 

  7. Quarles LD: FGF23, PHEX, and MEPE regulation of phosphate homeostasis and skeletal mineralization. Am J Physiol Endocrinol Metab 2003, 285:E1–E9.

    PubMed  CAS  Google Scholar 

  8. Ritz E, Gross ML: Hyperphosphatemia in renal failure. Blood Purif 2005, 23:6–9.

    Article  PubMed  Google Scholar 

  9. Santos FR, Moysés RM, Montenegro FL, et al.: IL-1beta, TNF-alpha, TGF-beta, and bFGF expression in bone biopsies before and after parathyroidectomy. Kidney Int 2003, 63:899–907.

    Article  PubMed  Google Scholar 

  10. Kanatani M, Sugimoto T, Kano J, et al.: Effect of high phosphate concentration on osteoclast differentiation as well as bone resorbing activity. J Cell Physiol 2003, 196:180–189.

    Article  PubMed  CAS  Google Scholar 

  11. Larsson T, Marsell R, Schipani E, et al.: Transgenic mice expressing fibroblast growth factor 23 under the control of the alpha1(I) collagen promoter exhibit growth retardation, osteomalacia, and disturbed phosphate homeostasis. Endocrinology 2004, 145:3087–3094.

    Article  PubMed  CAS  Google Scholar 

  12. Panda DK, Miao D, Bolivar I, et al.: Inactivation of the 25-hydroxyvitamin D 1alpha-hydroxylase and vitamin D receptor demonstrates independent and interdependent effects of calcium and vitamin D on skeletal and mineral homeostasis. J Biol Chem 2004, 279:16754–16766.

    Article  PubMed  CAS  Google Scholar 

  13. Gal-Moscovici A, Sprague S: Bone health in chronic kidney disease-mineral bone density. Adv Chronic Kidney Dis 2007, 14:27–36.

    Article  PubMed  Google Scholar 

  14. WHO Study Group: Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Geneva, Switzerland: World Health Organization; 1994.

    Google Scholar 

  15. Borah B, Gross GJ, Dufresne TE, et al.: Three dimensional microimaging (MRmicroI and microCT), finite element modeling, and rapid prototyping provide unique insights into bone architecture in osteoporosis. Anat Rec 2001, 265:101–110.

    Article  PubMed  CAS  Google Scholar 

  16. Seeman E, Delmas PD: Bone quality-the material and structural basis of bone strength and fragility. N Engl J Med 2006, 354:2250–2261.

    Article  PubMed  CAS  Google Scholar 

  17. Fontaine MA, Albert A, Dubois B, et al.: Fracture and bone mineral density in hemodialysis patients. Clin Nephrol 2000, 54:218–226.

    PubMed  CAS  Google Scholar 

  18. Ureña P, Bernard-Poenaru O, Ostertag A, et al.: Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 2003, 18:2325–2331.

    Article  PubMed  Google Scholar 

  19. Negri AL, Barone R, Quiroga MA, et al.: Bone mineral density: serum markers of bone turnover and their relationships in peritoneal dialysis. Perit Dial Int 2004, 24:163–168.

    PubMed  Google Scholar 

  20. Díaz-Corte C, Fernández-Martín LJ, Barreto S, et al.: Effect of aluminum load on parathyroid hormone synthesis. Nephrol Dial Transplant 2001, 16:742–745.

    Article  PubMed  Google Scholar 

  21. Nordal KP: Calcium carbonate versus aluminum hydroxide as phosphate binder in hemodialysis patients. A randomized perspective study. Kidney Int 1996, 49:926.

    Google Scholar 

  22. Sprague SM: Aluminum: its measurement and metabolism. Sem Dialysis 1988, 1:103–111.

    Article  Google Scholar 

  23. Sprague SM, Abboud H, Qui P, et al.: Lanthanum carbonate reduces phosphorus burden in patients with CKD stages 3 and 4: a randomized trial. Clin J Am Soc Nephrol 2009, 4:178–185.

    Article  PubMed  CAS  Google Scholar 

  24. Ketteler M, Rix M, Fan S, et al.: Efficacy and tolerability of sevelamer carbonate in hyperphosphatemic patients who have chronic kidney disease and are not on dialysis. Clin J Am Soc Nephrol 2008, 3:1125–1130.

    Article  PubMed  CAS  Google Scholar 

  25. D’Haese PC, Spasovski GB, Sikole A, et al.: A multicenter study on the effect of lanthanum carbonate (Fosrenol) and calcium carbonate on renal bone disease in dialysis patients. Kidney Int 2003, 85:S73–S78.

    Article  Google Scholar 

  26. González EA, Sachdeva A, Oliver DA, Martin KJ: Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004, 24:503–510.

    Article  PubMed  Google Scholar 

  27. Zisman AL, Hristova M, Ho LT, Sprague SM: Impact of ergocalciferol treatment of vitamin D deficiency on serum parathyroid hormone concentrations in chronic kidney disease. Am J Nephrol 2007, 27:36–43.

    Article  PubMed  CAS  Google Scholar 

  28. Coburn J, Maung HM, Elangovan L, et al.: Doxercalciferol safely suppresses PTH levels in patients with secondary hyperparathyroidism associated with chronic kidney diseases stages 3 and 4. Am J Kidney Dis 2004, 43:877–890.

    Article  PubMed  CAS  Google Scholar 

  29. Takahashi F, Finch JL, Denda M, et al.: A new analog of 1,25-(OH)2D3, 19-NOR-1,25-(OH)2D2, suppresses serum PTH and parathyroid gland growth in uremic rats without elevation of intestinal vitamin D receptor content. Am J Kidney Dis 1997, 30:105–112.

    Article  PubMed  CAS  Google Scholar 

  30. Slatopolsky E, Finch J, Ritter C, et al.: A new analog of calcitriol, 19-nor-1,25-(OH)2D2, suppresses parathyroid hormone secretion in uremic rats in the absence of hypercalcemia. Am J Kidney Dis 1995, 26:852–860.

    Article  PubMed  CAS  Google Scholar 

  31. Sprague SM, Llach F, Amdahl M, et al.: Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int 2003, 63:1483–1490.

    Article  PubMed  CAS  Google Scholar 

  32. Coyne D, Acharya M, Qui P, et al.: Paricalcitol capsule for the treatment of secondary hyperparathyroidism in stages 3 and 4 CKD. Am J Kidney Dis 2006, 47:263–276.

    Article  PubMed  CAS  Google Scholar 

  33. Slatopolsky E, Cozzolino M, Lu Y, et al.: Efficacy of 19-Nor-1,25-(OH)2D2 in the prevention and treatment of hyperparathyroid bone disease in experimental uremia. Kidney Int 2003, 63:2020–2027.

    Article  PubMed  CAS  Google Scholar 

  34. Jokihaara J, Pörsti I, Pajamäki I, et al.: Paricalcitol [19-nor-1,25-(OH)2D2] in the treatment of experimental renal bone disease. J Bone Miner Res 2006, 21:745–751.

    Article  PubMed  CAS  Google Scholar 

  35. Miller PD: Treatment of osteoporosis in chronic kidney disease and end-stage renal disease. Curr Osteoporos Rep 2005, 3:5–12.

    Article  PubMed  Google Scholar 

  36. Miller PD: Bisphosphonates: pharmacology and use in the treatment of osteoporosis. In Osteoporosis, edn 3. Edited by Marcus R, Feldman D, Nelson DA, Rosen CJ. San Diego, CA: Elsevier Academic Press; 2007:1725–1736.

    Google Scholar 

  37. Eisman JA, Civetelli R, Adami S, et al.: Efficacy and tolerability of intravenous ibandronate injections in postmenopausal osteoporosis: 2-year results from the DIVA study. J Rheumatol 2008, 35:488–497.

    PubMed  CAS  Google Scholar 

  38. Black DM, Delmas PD, Eastell RR, et al.: Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007, 356:1809–1822.

    Article  PubMed  CAS  Google Scholar 

  39. Lewiecki EM, Miller PD: Renal safety of intravenous bisphosphonates in the treatment of osteoporosis. Expert Opin Drug Saf 2007, 6:663–672.

    Article  PubMed  CAS  Google Scholar 

  40. Miller PD, Schwartz EN, Chen P, et al.: Teriparatide in postmenopausal women with osteoporosis and impaired renal function. Osteoporosis Int 2007, 18:59–68.

    Article  CAS  Google Scholar 

  41. Miller PD, Roux C, Boonen S, et al.: Safety and efficacy of risedronate in patients with age-related reduced renal function as estimated by the Cockcroft and Gault method: a pooled analysis of nine clinical trials. J Bone Miner Res 2005, 20:2105–2115.

    Article  PubMed  CAS  Google Scholar 

  42. Jamal SA, Bauer DC, Ensrud KE, et al.: Alendronate treatment in women with normal to severely impaired renal function: an analysis of the fracture intervention trial. J Bone Miner Res 2007, 22:503–508.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Stuart M. Sprague.

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Barnato, S., Sprague, S.M. Advances in renal bone disease: Osteoporosis and chronic kidney disease. Curr Rheumatol Rep 11, 185–190 (2009). https://doi.org/10.1007/s11926-009-0025-1

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