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Bone and Kidney Disease: Diagnostic and Therapeutic Implications

  • OSTEOPOROSIS AND METABOLIC BONE DISEASE (KG SAAG, SECTION EDITOR)
  • Published:
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Abstract

Fractures are common in patients with chronic kidney disease (CKD), but the diagnosis and treatment of bone disease in CKD are difficult due to the multiple etiologies of bone disease in these patients. Noninvasive imaging, including bone mineral density by dual energy x-ray absorptiometry, can be useful in diagnosing osteoporosis in predialysis CKD; however, consensus on the diagnosis of osteoporosis among those with advanced CKD—particularly stage 5 CKD patients on dialysis—is lacking. Treatments approved for osteoporosis in postmenopausal women may be used in patients with stage 1 to 3 CKD. Furthermore, post-hoc analyses show efficacy and safety of oral bisphosphonates, raloxifene, and denosumab in stage 4 CKD for short-term treatment. However, treatment decisions are more difficult in stage 5 CKD. Bone biopsy may be required, and most treatments, if used, would be off label. Overall, the diagnosis and treatment of bone disease in patients with CKD require further research.

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Disclosure

Dr. Jamal has served on boards for Amgen, Novartis, and Warner Chilcott; has served as a consultant for Novartis, Warner Chilcott, Genzyme Corp., and Shire; has received honoraria from Amgen, Novartis, Genzyme Corp., Shire, and Warner Chilcott; has served on the speakers’ bureau for Amgen; and has had travel/accommodations expenses covered/reimbursed by Amgen, Novartis, Genzyme Corp., Shire, and Warner Chilcott.

Dr. Miller has served on boards for WCX, Merck & Co., Eli Lilly and Company, Novartis, and Amgen; has served as a consultant for WCX, Eli Lilly and Company, Amgen, and Novartis; has provided expert testimony on behalf of Novartis and Merck & Co.; has received grant support from WCX, Genentech, Eli Lilly and Company, Merck & Co., Novartis, Amgen, and Takeda Pharmaceuticals North America; and has had travel/accommodations expenses covered/reimbursed by WCX, Amgen, and Novartis.

Ms. West reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. University of Toronto, Women’s College Hospital, 790 Bay Street, Toronto, Ontario, M5G 1N8, Canada

    Sophie A. Jamal & Sarah L. West

  2. University of Colorado Health Sciences Center, Colorado Center for Bone Research, 3190 South Wadsworth Boulevard, Denver, CO, 80227, USA

    Paul D. Miller

Authors
  1. Sophie A. Jamal
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  2. Sarah L. West
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  3. Paul D. Miller
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Correspondence to Sophie A. Jamal.

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Jamal, S.A., West, S.L. & Miller, P.D. Bone and Kidney Disease: Diagnostic and Therapeutic Implications. Curr Rheumatol Rep 14, 217–223 (2012). https://doi.org/10.1007/s11926-012-0243-9

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  • DOI: https://doi.org/10.1007/s11926-012-0243-9

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