Figure - available from: Endocrine
This content is subject to copyright. Terms and conditions apply.
Source publication
This article aims to review the methods used for the assessment of fracture risk and the use of osteoporosis medications for fracture prevention in the population with CKD, and highlights the difficulties faced by clinicians in the management of these patients and the latest recommendations and guidelines. Chronic kidney disease (CKD) and osteoporo...
Similar publications
Chronic kidney disease is a health problem whose prevalence is increasing worldwide. The kidney plays an important role in the metabolism of minerals and bone health and therefore, even at the early stages of CKD, disturbances in bone metabolism are observed. In the course of CKD, various bone turnover or mineralization disturbances can develop inc...
Citations
... Although Dmab has been shown to improve bone quality in secondary osteoporosis, this was mainly at the LS [27]. Our results show an attenuation of Dmab effects on the HSA parameters in secondary osteoporosis, particularly at the FS although this may be driven by the effects of CKD on cortical bone [28]. ...
Purpose
The aim of this study was to evaluate changes in hip geometry parameters following treatment with teriparatide (TPD), denosumab (Dmab) and zoledronate (ZOL) in real-life setting.
Methods
We studied 249 patients with osteoporosis (OP) with mean [SD] age of 71.5 [11.1] years divided into 3 treatment groups; Group A received TPD; n = 55, Group B (Dmab); n = 116 and Group C (ZOL); n = 78 attending a routine metabolic bone clinic. Bone mineral density (BMD) was measured by DXA at the lumbar spine (LS), total hip (TH) and femoral neck (FN) prior to treatment and after 2 years (Group A), after a mean treatment duration of 3.3 [1.3] years (Group B) and after 1, 2 and 3 doses of ZOL (Group C) to assess treatment response. Hip structural analysis (HSA) was carried out retrospectively from DXA-acquired femur images at the narrow neck (NN), the intertrochanter (IT) and femoral shaft (FS).
Results
Changes in p arameters of hip geometry and mechanical strength were seen in the following treatment. Percentage change in cross-sectional area (CSA): 3.56[1.6] % p = 0.01 and cross-sectional moment of inertia (CSMI): 4.1[1.8] % p = 0.029 increased at the NN only in Group A. Improvement in HSA parameters at the IT were seen in group B: CSA: 3.3[0.67]% p < 0.001, cortical thickness (Co Th): 2.8[0.78]% p = 0.001, CSMI: 5.9[1.3]% p < 0.001, section modulus (Z):6.2[1.1]% p < 0.001 and buckling ratio (BR): − 3.0[0.86]% p = 0.001 with small changes at the FS: CSA: 1.2[0.4]% p = 0.005, Z:1.6 [0.76]%, p = 0.04 . Changes at the IT were also seen in Group C (after 2 doses): CSA: 2.5[0.77]% p = 0.017, Co Th: 2.4[0.84]% p = 0.012, CSMI: 3.9[1.3]% p = 0.017 , Z:5.2[1.16]% p < 0.001 and BR: − 3.1[0.88]% p = 0.001 and at the NN (following 3 doses): outer diameter (OD): 4.0[1.4]% p = 0.0005, endocortical diameter(ED): 4.3[1.67% p = 0.009, CSA:5.2[1.8]% p = 0.003, CSMI: 9.3[3.8]% p = 0.019 .
Conclusions
Analysis of the effect of OP therapies on hip geometry is useful in understanding the mechanisms of their anti-fracture effect and may provide additional information on their efficacy.
... Renal osteodystrophy is expressed as a component of the syndrome called Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD), which causes bone fractures, vascular calcification and mortality. However, moderate and advanced CKD patients are usually elderly individuals and may also experience age-related or post-menopausal osteoporosis alongside declining kidney function [9]. Osteoporosis is a progressive bone disease that results in increased bone fragility due to low bone mineral density (BMD) and deterioration of the microarchitecture of bone tissue [8]. ...
... Osteoporosis often coexists with CKD, and the global prevalence of both is increasing day by day. Osteoporotic fractures, which cause increased disability and reduced survival, cost 5.8 million disability-adjusted life years (DALYs) annually worldwide [9]. ...
... In hemodialysis patients, this deficiency reaches up to 80% [40]. Aging, corticosteroid use, and obesity have also been suggested to affect the vitamin D status in patients with CKD [9,33,37]. Although there is no international consensus regarding the optimal dose, most observational and randomized controlled studies have shown that nutritional vitamin D supplementation promotes bone health [19,41]. ...
The prevalence of vitamin D deficiency is high in patients with chronic kidney disease (CKD). Vitamin D deficiency is associated with various bone disorders such as osteoporosis by affecting bone mineralization. Current international guidelines recommend vitamin D supplementation in CKD as well as in the general population. However, the effect of various forms of vitamin D on bone health in CKD remains unclear. Few randomized controlled studies have evaluated the effects of vitamin D supplementation on bone mineral density and bone turnover markers; however, the findings of these studies are heterogeneous. This review aimed to present comprehensive and current findings on the effects of native vitamin D supplementation on bone biomarkers and bone mineral density in CKD. We infered that native vitamin D treatment could improve some bone biomarkers, particularly in predialysis CKD patients with severe vitamin D deficiency. Our findings also draw attention to the fact that vitamin D is an important factor in treatment. However, it is essential to design better-quality and comprehensive controlled studies to obtain clear findings.
... Los cuales irían en detrimento de la poca independencia que tienen. Para terminar, el paciente geriátrico, es aquel cuya independencia es nula y necesitan apoyo constante en sus tareas diarias (Hampson et al., 2021). ...
Introducción. La insulinización es un tratamiento destinado a pacientes con diabetes mellitus (DM). En especial, en edades tempranas y a pacientes con DM tipo 1. Sin embargo, su uso también se ha probado en pacientes con DM tipo 2, en cualquier grupo etario incluyendo adultos mayores. Objetivo. Detallar la insulinización en adultos mayores con diabetes mellitus tipo 2. Metodología. Se realizó una revisión bibliográfica tipo narrativa basada en el uso de artículos científicos como fuentes bibliográficas. La búsqueda de dichos artículos se realizó en plataformas digitales y bases de datos exclusivamente de áreas de salud: Springer, Elsevier, Pubmed Central, entre otros. Para perfeccionar las búsquedas, se utilizaron palabras clave a modo de descriptores, tanto en idioma inglés como español. Para mejorar los resultados, se apoyó la búsqueda con operadores booleanos como AND Y OR. Se utilizó el modelo PRISMA para el cribado de los artículos. Resultados. De un total de 80 artículos revisados, 15 cumplieron con los requisitos de la presente revisión. Las indicaciones para iniciar la insulinización en adultos mayores es el fracaso a tratamientos con antidiabéticos orales, enfermedades cardiovasculares con falta de control, enfermedad renal o hepática crónicas, y en aquellos pacientes hospitalizados bajo vigilancia médica. Conclusión. Las ventajas de la insulinización tienen que ver con la facilidad de autoadministración, incluso en edades avanzadas. Las complicaciones más importantes son hipoglucemia, aumento de peso y en menor porcentaje hematomas locales. Área de estudio general: medicina. Área de estudio específica: medicina general.
... Patients with decreased kidney function and chronic kidney disease (CKD) have an increased risk of osteoporosis and fragility fractures [1,2]. Drugs used for treatment of osteoporosis have been investigated in, and are primarily approved for, patients with normal kidney function. ...
Introduction
Little is known about treatment of osteoporosis with denosumab (Prolia®) in patients with decreased kidney function. The aim of this retrospective case report study was to investigate effects and side-effects of such treatment.
Methods
Since 2012, 75 patients with osteoporosis and decreased kidney function had been treated with denosumab (Prolia®) in the osteoporosis outpatient clinic of the department of endocrinology, Bispebjerg Hospital, University of Copenhagen, Denmark, and data were retrospectively collected from the patient records of these patients in 2021.
Results
At baseline, the mean estimated glomerular filtration rate (eGFR) was 34 mL/min (range 9–50) and the median age was 85 years (range 45–103). 95% of the patients had had low-energy fractures, and the bone mineral density T score of the hips was on average − 2.7. All, but one, patients had normal/high parathyroid hormone (PTH) levels.
The mean duration of the treatment with denosumab at the follow-up was 5.3 years (range 1.5–10). There was an annual increase of 12% and of 7% in the T score of in the lumbar spine and hip, respectively, compared to the T -scores prior to the denosumab treatment. 20% had a new fracture during the follow-up. 21% had biochemical hypocalcemia following denosumab injection, 7% developed symptoms of hypocalcemia, whereas 4% needed to be hospitalized acutely.
Conclusion
Treatment with denosumab of osteoporosis in patients with decreased kidney function (eGFR 9–50 mL/min), with normal/high PTH, seems in general to be well tolerated, with improvement of bone and decreased risk of new fractures.
... Osteoporosis is defined as a systemic, skeletal disorder, where bone strength and resistance are compromised, and thus, affected patients have an elevated risk of fracture due to reduction in bone mass density (BMD, mineral quantity per square centimeter, expressed as g/cm 2 ) and bone quality (BQ, comprehensive of microarchitecture, mineralization, turnover, and microcrack accumulation) [23][24][25][26][27][28]. According to the World Health Organization (WHO), "osteoporosis is defined as a BMD that lies 2.5 standard deviations or more below the average value for young healthy women (a T-score of < −2.5 SD)". ...
... Conversely, in adynamic bone disease, low bone turnover is common, due to reduced osteoblasts and osteoclasts activity. The ability of bone to release or store calcium is consequently compromised, resulting in broad oscillation of calcium levels [24,25]. ...
Vitamin D belongs to the group of liposoluble steroids mainly involved in bone metabolism by modulating calcium and phosphorus absorption or reabsorption at various levels, as well as parathyroid hormone production. Recent evidence has shown the extra-bone effects of vitamin D, including glucose homeostasis, cardiovascular protection, and anti-inflammatory and antiproliferative effects. This narrative review provides an overall view of vitamin D’s role in different settings, with a special focus on chronic kidney disease and kidney transplant.
... There is also evidence that women are more susceptible to CKD [14] and women are an independent risk factor for fracture in hemodialysis patients [15]. Therefore, in CKD patients with fracture, the result that there are more women than men is no exception [16]. Among the patients, we included 80-84 years old CKD with fracture accounted for the largest proportion. ...
Background
The aim of this study was to analyze the clinical characteristics of older fracture patients with chronic kidney disease (CKD) and to determine the risk factors of perioperative cardiovascular complications.
Methods
We retrospectively reviewed clinical data of older fracture patients with CKD admitted to the Third Hospital of Hebei Medical University from January 2016 to October 2021. The data we collected included baseline characteristics and complications. We finally determined the risk factors of perioperative cardiovascular complications by using logistic regression.
Results
We ended up enrolling 224 patients, and there were 91 (40.6%) males and 133 (59.4%) females, with a median age of 79 years. 80–84 years old was the age group with high incidence of fracture. The majority of fracture occurred indoors (130 cases, 58.0%) and morning (98 cases, 43.8%). Hip fracture was most common (183 cases, 81.7%), of which femoral neck fracture (101 cases, 45.0%) was the most prevalent. The most common comorbid condition was hypertension (171 cases, 76.3%), and anemia was the most common complication (148 cases, 66.1%). Age ≥ 80 years (OR = 2.023, 95% CI 1.110–3.688), previously combined with cardiovascular calcification (OR = 1.901, 95% CI 1.047–3.451) and admission hemoglobin level < 100 g/L (OR = 3.191, 95% CI 1.744–5.838) were independent risk factors of perioperative cardiovascular disease (CVD).
Conclusion
It was especially necessary to enhance fracture prevention for CKD. Patients whose age older than 80, hemoglobin less than 100 g/L on admission and have previous cardiovascular calcification are more likely to develop perioperative CVD. Such patients require reasonable decisions during the perioperative period to avoid the occurrence of CVD.
... In fact, serum PTH values generally increase when estimated glomerular filtration rate falls below 60 mL/min/1.73 m2 [46]. However, we found a positive correlation between the length of the diagnostic delay and both the age at acromegaly diagnosis and the age at the last follow-up. ...
Introduction
Acromegaly is a chronic disease with systemic complications. Disease onset is insidious and consequently typically burdened by diagnostic delay. A longer diagnostic delay induces more frequently cardiovascular, respiratory, metabolic, neuropsychiatric and musculoskeletal comorbidities. No data are available on the effect of diagnostic delay on skeletal fragility. We aimed to evaluate the effect of diagnostic delay on the frequency of incident and prevalent of vertebral fractures (i-VFs and p-VFs) in a large cohort of acromegaly patients.
Patients and methods
A longitudinal, retrospective and multicenter study was conducted on 172 acromegaly patients.
Results
Median diagnostic delay and duration of follow-up were respectively 10 years (IQR: 6) and 10 years (IQR: 8). P-VFs were observed in 18.6% and i-VFs occurred in 34.3% of patients. The median estimated diagnostic delay was longer in patients with i-VFs (median: 11 years, IQR: 3), in comparison to those without i-VFs (median: 8 years, IQR: 7; p = 0.02). Age at acromegaly diagnosis and at last follow-up were higher in patients with i-VFs, with respect to those without i-VFs. The age at acromegaly diagnosis was positively associated with the diagnostic delay (p < 0.001, r = 0.216). A longer history of active acromegaly was associated with a high frequency of i-VFs (p = 0.03). The logistic regression confirmed that patients with a diagnostic delay > 10 years had 1.5-folds increased risk of developing i-VFs (OR: 1.5; 95%CI: 1.1–2; p = 0.017).
Conclusion
Our data showed that the diagnostic delay in acromegaly has a significant impact on VF risk, further supporting the clinical relevance of an early acromegaly diagnosis.
... Osteoporosis and chronic kidney disease e treatment recommendations Similar to others at a high fracture risk, and as part of primary or secondary fracture prevention, patients with CKD/CKD-MBD should receive pharmacological treatment for osteoporosis [17,18]. Therapy in CKD-MBD patients should be optimized according to guidelines before pharmacological fracture intervention is initiated [1,15]. ...
... Romosozumab, although approved for the treatment of osteoporosis without eGFR cut-off, has scarce data on its efficacy in CKD patients. As with denosumab, romosozumab should be followed by an anti-resorptive agent to avoid bone loss after withdrawal [17,18]. ...
Chronic kidney disease and osteoporosis commonly co-exist in aged patients. Chronic kidney disease affects bone health because of its effect on mineral metabolism in the syndrome, Chronic Kidney Disease Mineral and Bone Disorder, resulting in an increased risk of fractures. Hip fracture risk may be as much as four-fold higher in the worst affected. Tools to estimate fracture risk such as FRAX® and measuring bone density can be used in patients with chronic kidney disease; however, bone density may underestimate fracture risk in this population as it does not give information on bone quality. While osteoporosis treatment in patients with chronic kidney disease stage 1–3 does not differ from the general population, in the absence of Chronic Kidney Disease Mineral and Bone Disorder, patients with disease stage 4–5 require special consideration. It is, however, of the utmost importance that these patients receive pharmacological treatment because of their high risk of fractures.
... 98 In CKD stage 4 with high risk of fracture in younger adults, Hampson suggested considering denosumab or off-label prescription of bisphosphonate. 99 Bone turnover must be explored (bone biopsy, biomarkers) to validate the absence of ABD when antiresorptive drugs have no effect. If this option is retained, the recommendation for patients with low BMD and reduced life expectancy is to keep the therapy to the end, making it suitable also in older CKD patients. ...
Pierre-Emmanuel Cailleaux, Martine Cohen-Solal Inserm UMR-S 1132 Bioscar, Université Paris Cité - Hôpital Lariboisiere, Paris, F-75010, FranceCorrespondence: Martine Cohen-Solal, Inserm UMR-S 1132 (Université Paris Cité), Hôpital Lariboisière, 2 rue Ambroise Paré, Paris, F-75010, France, Tel/Fax +33-1-49-95-63-58, Email martine.cohen-solal@inserm.frAbstract: Aging represents a major concern, with a two-fold increase in individuals > 65 years old by 2040. Older patients experience multiple declines in condition, with overlapping concerns. Fractures, frailty and falls remain underestimated events in routine practice. They are shared by numerous conditions and diseases, such as osteoporosis, sarcopenia and undernutrition, which mostly feature low evolution and are silent. In this review, we focused on musculoskeletal decline in older individuals who also have chronic kidney disease (CKD), which promotes fractures and falls. We aimed to highlight the need for a global approach for musculoskeletal and kidney aging. Although strategies limiting falls remain controversial, the need for an early diagnosis can limit these declines and allow for specific treatment of bone fragility in addition to non-pharmacological approaches. The emergence of senolytic agents offers new hope for preventing musculoskeletal disorders. This scoping review describes these overlapping silent diseases, provides evidence for their global understanding and management, and sheds light on new therapeutic directions.Keywords: older individuals, osteoporosis, sarcopenia, kidney disease, senolytics
... Клиничните рискови фактори за фрактури на костите, които не са непосредствено свързани с нарушението на костния и минерален метаболизъм при болните с хронично бъбречно заболяване, също трябва да се оценяват заедно с това нарушение за постигане на оптимална оценка на риска за тези фрактури (10). Алгоритъмът FRAX интегрира тези рискови фактори с нарушението на костния и минерален метаболизъм и осигурява десетгодишна вероятност за поява на фрактура на бедрената кост. ...
... Алгоритъмът FRAX интегрира тези рискови фактори с нарушението на костния и минерален метаболизъм и осигурява десетгодишна вероятност за поява на фрактура на бедрената кост. Факторите, които са най-чести при болните с хронично бъбречно заболяване, са следните: вторичният хиперпаратиреоидизъм, фактори, свързани с хемодиализата и уремията, метаболитната ацидоза, недохранването, периферната невропатия, мускулната слабост, липсата на равновесие, повишеният риск за саркопения и падания, невропознавателната дисфункция, захарният диабет, сърдечно-съдовото заболяване и съдовите калцификати (10). ...
... Необходими са рутинна оценка на този риск и профилактика на счупванията на костите при болните с хронично бъбречно заболяване (10). ...
Bone fractures are common complications in chronic kidney disease patients. In the present concise survey, the newest data about the considerable risk for these fractures available in the foreign literature are presented. The important role of modern biochemical examination and image diagnosis in bone and mineral metabolism disorders, which contribute to the identification of the degree of the risk for bone fractures in chronic kidney disease, is discussed. The occurrence of these serious complications as a result of the hemodialysis carried out deserves a special attention. An advance in terms of the effectiveness of the drug treatment of the osseous alterations with the purpose of fracture risk reduction in chronic kidney disease patients has been achieved.
