Disease diagnosis and treatment | Why do we need to undergo bone-related detections when there is a kidney problem?

Mr. Johnathan, a 40-year-old male, was recently diagnosed with chronic kidney disease (CKD). During a follow-up visit, his doctor ordered a bone metabolism test, which puzzled Mr. Johnathan. When he asked why, the doctor explained that CKD patients are at higher risk for osteoporosis. The bone metabolism test helps identify bone issues early, allowing for timely intervention to prevent fractures.

PART 1: Why are CKD patients prone to osteoporosis?

On the one hand, the kidneys' decreased function in activating vitamin D leads to low blood calcium. Conversely, renal insufficiency occurs in phosphorus excretion disorders, resulting in phosphorus retention and blood phosphorus elevation. Low calcium and high phosphorus jointly stimulate the secretion of parathyroid PTH, eventually leading to secondary hyperparathyroidism, and secondary osteoporosis [1-5].

PART 2: What is the incidence rate of osteoporosis in CKD patients?

CKD is estimated to affect about 8% to 16% of the global population [6]. Around 772 million individuals are diagnosed with CKD worldwide [7]. Osteoporosis is one of the most common complications of CKD. Data shows that the incidence of osteoporosis in CKD patients is as high as 47.1% [8].

Osteoporosis can lead to bone or joint pain, an increased risk of fractures, and increased disability and mortality rates in CKD patients. Therefore, early diagnosis and management are crucial for avoiding long-term and catastrophic consequences [10], in order to detect and predict the risk of fractures early and take standardized prevention and treatment measures.

PART 3: Preventive evaluation recommendations for osteoporosis in CKD patients [12]

The recommendations for the prevention and evaluation of osteoporosis in CKD patients in the Chinese Guidelines for the Diagnosis and Treatment of Mineral and Bone Abnormalities in Chronic Kidney Disease are as follows:

(1) Suggested frequency of monitoring biochemical indicators (Not Graded):

-Check serum calcium, phosphorus, and ALP levels every 6–12 months;

-Determine the interval between iPTH examinations based on the baseline level of iPTH and the progression of CKD;

-When conditions permit, it is recommended to test for 25 (OH) D levels and determine the frequency of repeat testing based on baseline levels and treatment interventions.

(2) It is recommended to regularly measure the bone density of the lumbar spine and hip joints in CKD patients in stages G1-G2 to evaluate the presence of osteoporosis. (Not Graded)

(3) It is recommended to measure bone density in patients with chronic kidney disease mineral and bone abnormalities (CKD-MBD) and/or osteoporosis risk during the G3a-G5D phase of CKD to assess fracture risk. (2B)

(4) It is suggested to predict the risk of osteoporotic fractures in CKD patients. The most commonly used prediction method is the WHO Fracture Risk Prediction Tool (FRAX). (Not Graded)

PART 4: Bone metabolism markers assist in the management of CKD bone health

Bone turnover is crucial for maintaining mineral balance in the body, and imbalanced bone turnover is a key pathological and physiological mechanism of osteoporosis. Snibe provides a comprehensive diagnostic solution for bone metabolism that can be used for differential diagnosis of osteoporosis in various bone diseases, prediction of fracture risk, evaluation of drug efficacy, and other aspects [13], assisting in the management of bone health in CKD patients with excellent sensitivity, specificity, and accuracy of detection results.

In summary, CKD patients have a significantly increased risk of osteoporosis and fractures. While focusing on controlling the progression of kidney disease, clinical physicians also need to pay attention to the bone health of CKD patients and take prompt actions in the clinical prevention and treatment of CKD osteoporosis.

References:

1.ViEgas C et al. Aging (Albany NY). 2019 Jun 26; 11(12):4274-4299?

2.Seiler S et al, kidney lnt. 2009,76, S34-S42?

3.Komaba H et al, kidney Int. 2016 Oct; 90(4):753-63??

4.KDIGO Work Group. Kidney Int Suppl 2009,76(13):S1-S130 ;?

5.Bergwitz C, et al, Annu Rev Med 2010,61:91-104

6.Connelly K, Collister D, Tangri N. Curr Opin Nephrol Hypertens. 2018;27:221–225

7.Khairallah P, Nickolas TL. Curr Osteoporos Rep. 2018;16:712–723.

8.Kinsella S, et al. Nephron Clin Pract. 2010;116(3):c256-62.

10.Abdalbary, M., Sobh, M., Elnagar, S. et al.

11.Abdalbary M, et al. Osteoporos Int. 2022 Jun 24.

12.《中国慢性肾脏病矿物质和骨异常诊治指南》

13.中华骨质疏松和骨矿盐疾病杂志.2022.15(6):573-611.