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Positioning novel biologicals in CKD-mineral and bone disorders

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Abstract

Renal osteodystrophy (ROD), the histologic bone lesions of chronic kidney disease (CKD), is now included in a wider syndrome with laboratory abnormalities of mineral metabolism and extra-skeletal calcifications or CKD-mineral and bone disorders (CKD-MBD), to highlight the increased burden of mortality. Aging people, frequently identified as early CKD, could suffer from either the classical age-related osteoporosis (OP) or ROD. Distinguishing between these two bone diseases may not be easy without bone biopsy. In any case, besides classical therapies for ROD, nephrologists are now challenged by the possibility of using new drugs developed for OP. Importantly, while therapies for ROD mostly aim at controlling parathyroid secretion with bone effects regarded as indirect, new drugs for OP directly modulate bone cells activity. Thus, their action could be useful in specific types of ROD. Parathyroid hormone therapy, which is anabolic in OP, could be useful in renal patients with low turnover bone disease. Denosumab, the monoclonal antibody against receptor activator of NF-κB ligand (RANK-L) that inhibits osteoclast activity and proliferation, could be beneficial in cases with high turnover bone. Use of romosozumab, the monoclonal antibody against sclerostin, which both stimulates osteoblasts and inhibits osteoclasts, could allow both anabolic and anti-resorptive effects. However, we should not forget the systemic role now attributed to CKD-MBD. In fact, therapies targeting bone cells activity could also result in unpredicted extra-bone effects and affect cardiovascular outcomes. In conclusion, the new biologicals established for OP could be useful in renal patients with either OP or ROD. In addition, their potential non-bone effects warrant investigation.

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Authors and Affiliations

  1. Department of Cardiovascular, Respiratory, Nephrologic, Anesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy

    Lida Tartaglione, Silverio Rotondi, Maria Luisa Muci & Sandro Mazzaferro

  2. Department of Nephrology and Dialysis, University Hospital Company, Policlinico Umberto I, Rome, Italy

    Marzia Pasquali

  3. Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Adrian Covic

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  1. Lida Tartaglione
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  2. Marzia Pasquali
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  3. Silverio Rotondi
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  4. Maria Luisa Muci
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  6. Sandro Mazzaferro
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Correspondence to Sandro Mazzaferro.

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LT: no conflict of interests to declare; MP: no conflict of interests to declare; SR: no conflict of interests to declare; MML: no conflict of interests to declare; AC: consultant for FMC; SM: clinical investigation fundings from Amgen.

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Tartaglione, L., Pasquali, M., Rotondi, S. et al. Positioning novel biologicals in CKD-mineral and bone disorders. J Nephrol 30, 689–699 (2017). https://doi.org/10.1007/s40620-017-0410-1

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