Bone health in chronic kidney disease-mineral and bone disorder: a clinical case seminar and update

Jasna Aleksova, Kong W. Ng, Caroline Jung, Howard Zeimer, Karen M. Dwyer, Frances Milat, Richard J. MacIsaac

Research output: Contribution to journalReview ArticleOtherpeer-review

Abstract

The metabolic abnormalities affecting bone in the setting of chronic kidney disease (CKD) are complex with overlapping and interacting aetiologies and have challenging diagnostic and management strategies. Disturbances in calcium, phosphate, fibroblast growth factor 23, parathyroid hormone concentrations and vitamin D deficiency are commonly encountered and contribute to the clinical syndromes of bone disorders in CKD, including hyperparathyroidism, osteomalacia, osteoporosis and adynamic bone disease. Mineral and bone abnormalities may also persist or arise de novo post-renal transplantation. The Kidney Disease Improving Global Outcomes organisation describes these mineral metabolism derangements and skeletal abnormalities as ‘CKD Mineral and Bone Disorder’. Patients with this disorder have an increased risk of fracture, cardiovascular events and overall increased mortality. In light of the recently updated 2017 guidelines from the Kidney Disease Improving Global Outcomes, we present a clinical case-based discussion to highlight the complexities of investigating and managing the bone health of patients with CKD with a focus on these updates.

Original languageEnglish
Pages (from-to)1435-1446
Number of pages12
JournalInternal Medicine Journal
Volume48
Issue number12
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • chronic kidney disease
  • fracture
  • metabolic bone disease

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