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The Non-invasive Diagnosis of Bone Disorders in CKD

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Abstract

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.

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Acknowledgements

We thank Mr Ricard Pellejero for his extremely valuable bibliographic assistance.

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  1. Jordi Bover and Pablo Ureña-Torres have equally contributed as first authors.

Authors and Affiliations

  1. Department of Nephrology, Fundació Puigvert and Universitat Autònoma, IIB Sant Pau, REDinREN, C. Cartagena 340-350, 08025, Barcelona, Catalonia, Spain

    Jordi Bover

  2. Department of Dialysis, AURA Nord Saint Ouen and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France

    Pablo Ureña-Torres

  3. Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy

    Mario Cozzolino

  4. Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, REDinREN, Universidad de Oviedo, Oviedo, Spain

    Minerva Rodríguez-García

  5. Unidad de Gestión Clínica de Metabolismo Óseo y Mineral, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Spain

    Carlos Gómez-Alonso

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Correspondence to Jordi Bover.

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The authors declare no conflicts of interest related to this topic. JB declares advisory/lecture fees and/or travel funding from Amgen, Abbvie, Sanofi-Genzyme, Shire, Vifor-Fresenius-Renal Pharma, and Sanifit. PUT declares advisory/lecture fees and/or travel funding from Abbvie, Amgen, Astellas, Medici, Sanofi, Vifor-Pharma FMC, and Hémotech. MC declares advisory/lecture fees from Amgen, Abbvie, Shire, Vifor-Pharma, and Baxter. CGA declares advisory/lecture fees and/or travel funding from Amgen, Kiowa-Kirin, and FAES.

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Jordi Bover, Pablo Ureña-Torres and Mario Cozzolino are members of the ERA-EDTA CKD-MBD Working Group.

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Bover, J., Ureña-Torres, P., Cozzolino, M. et al. The Non-invasive Diagnosis of Bone Disorders in CKD. Calcif Tissue Int 108, 512–527 (2021). https://doi.org/10.1007/s00223-020-00781-5

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