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The Non-invasive Diagnosis of Bone Disorders in CKD
Calcified Tissue International ( IF 4.2 ) Pub Date : 2021-01-04 , DOI: 10.1007/s00223-020-00781-5
Jordi Bover 1 , Pablo Ureña-Torres 2 , Mario Cozzolino 3 , Minerva Rodríguez-García 4 , Carlos Gómez-Alonso 5
Affiliation  

Abnormal bone metabolism is an integral part of the chronic kidney disease-mineral bone disorder (CKD-MBD). For several reasons, the difficult bone compartment was neglected for some time, but there has been renewed interest as a result of the conception of bone as a new endocrine organ, the increasing recognition of the cross-talk between bone and vessels, and, especially, the very high risk of osteoporotic fractures (and associated mortality) demonstrated in patients with CKD. Therefore, it has been acknowledged in different guidelines that action is needed in respect of fracture risk assessment and the diagnosis and treatment of osteoporosis in the context of CKD and CKD-MBD, even beyond renal osteodystrophy. These updated guidelines clearly underline the need to improve a non-invasive approach to these bone disorders in order to guide treatment decisions aimed at not only controlling CKD-MBD but also decreasing the risk of fracture. In this report, we review the current role of the most often clinically used or promising biochemical circulating biomarkers such as parathyroid hormone, alkaline phosphatases, and other biochemical markers of bone activity as alternatives to some aspects of bone histomorphometry. We also mention the potential role of classic and new imaging techniques for CKD patients. Information on many aspects is still scarce and heterogeneous, but many of us consider that it is indeed time for action, recognizing our definitely limited ability to base certain treatment decisions only on our current non-comprehensive knowledge.



中文翻译:

CKD 骨病的无创诊断

骨代谢异常是慢性肾病-矿物质骨病 (CKD-MBD) 的一个组成部分。由于多种原因,困难的骨隔室被忽视了一段时间,但由于骨作为一种新的内分泌器官的概念,骨与血管之间的串扰的日益认识,特别是CKD 患者出现骨质疏松性骨折(和相关死亡率)的风险非常高。因此,不同的指南都承认,在 CKD 和 CKD-MBD 的背景下,甚至在肾性骨营养不良之外,还需要在骨折风险评估和骨质疏松症的诊断和治疗方面采取行动。这些更新的指南明确强调需要改进对这些骨骼疾病的非侵入性方法,以指导旨在不仅控制 CKD-MBD 还旨在降低骨折风险的治疗决策。在本报告中,我们回顾了临床上最常用或最有希望的生化循环生物标志物(如甲状旁腺激素、碱性磷酸酶和其他骨活动生化标志物)作为骨组织形态计量学某些方面的替代物的当前作用。我们还提到了经典和新成像技术对 CKD 患者的潜在作用。许多方面的信息仍然稀缺且异质性,但我们中的许多人认为确实是采取行动的时候了,认识到我们仅根据我们目前的非全面知识做出某些治疗决定的能力绝对有限。

更新日期:2021-01-05
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