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Dear Editor,
We appreciate the comment made by Dr Michael Pazianas on our review article [1] and thank his interest in our article.
Being true that a functioning kidney has a minimal contribution to the development of osteoporosis is also true that chronic kidney disease (CKD) stage 5 or 5d has different implications in bone health comparing to CKD stage 3 or even 4. And, in fact, CKD stage 5 relates to osteoporosis through CKD-MBD [2]. In addition, we refute that osteoporosis and renal osteodystrophy are always histologically different. Moreover, low remodelling in stages 3, 4 or 5 with low bone volume without mineralization defect shows the same histological features than low bone turnover osteoporosis in non-CKD patients that could explain the bone fragility.
We acknowledge the fact that bone mineral density measurements do not correlate with BV/TV measurements in uremic patients, and although osteoporosis is defined by T-scores of dual-energy X-ray absorptiometry (DEXA), this test should be interpreted with caution in CKD patients [3].
In summary, we agree with both nomenclatures of CKD-related osteoporosis and CKD-MBD/Osteoporosis, although we believe the first is more intuitive for our target readers.
References
Ferreira AC, Cohen-Solal M, D’Haese PC, Ferreira A, on behalf of the European Renal Osteodystrophy (EUROD), an initiative of the CKD-MBD working group of the ERA-EDTA (2021) The role of bone biopsy in the management of CKD-MBD. Calcif Tissue Int. http://doi.org/https://doi.org/10.1007/s00223-021-00838-z.
Bover J, Bailone L, Lopez-Baez V et al (2017) Osteoporosis, bone mineral density and CKD-MBD: treatment considerations. J Nephrol 30:677–687
Cunningham J, Sprague SM, Cannata-Andia J et al (2004) Osteoporosis in chronic kidney disease. Am J Kidney Dis 43:566–571
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Ana Carina Ferreira, Martine Cohen-Solal, Patrick C. D’Haese and Aníbal Ferreira declare that they have no conflict of interest.
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Ferreira, A.C., Cohen-Solal, M., D’Haese, P.C. et al. The Role of Bone Biopsy in the Management of CKD-MBD: CKD-Related Osteoporosis or CKD-MBD/Osteoporosis?. Calcif Tissue Int 109, 112 (2021). https://doi.org/10.1007/s00223-021-00854-z
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DOI: https://doi.org/10.1007/s00223-021-00854-z