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proLékaře.cz / Journals / Clinical Osteology / 2019 - 4

Densitometry in patients with chronic kidney disease

Czech version

Authors: Brunerová Ludmila
Authors‘ workplace: II. interní klinika 3. LF UK a FNKV, Praha
Published in: Clinical Osteology 2019; 24(4): 192-197
Category:

Overview

Advanced chronic kidney disease (CKD G3b-5) as CKD-MBD (mineral and bone disorder associated with CKD) is connected with low bone mineral density (BMD) and significantly increased fracture risk (2–100x) that has a significant negative impact on quality of life and prognosis of these patients. Bone histomorphonetry represents the gold standard for diagnostics of CKD-MBD bone disorder subtypes, however, due to several reasons it is performed rarely in clinical practice. Thus, more attention is paid to noninvasive differential diagnostic procedures (DXA, markers of bone turnover). Original 2009 KDIGO (Kidney Disease Improving Global Outcomes) guidelines strongly did not recommend DXA in this population because of the absence of data on prediction of fracture risk and non-specificity of DXA in different CKD-MBD bone disorder subtypes). Nonetheless, the proof of fracture prediction by DXA and high prevalence of osteoporosis led to revision of KDIGO guidelines and practically routine recommendation of DXA in CKD G3b-5D patients with CKD-MBD and/or risk factors of osteoporosis (if the results changes the therapy). However, there are some specificities of DXA assessment in these patients (more significant impairment of cortical bone, over-assessment of BMD in lumbar spine and some advantages of laterogram).

Keywords:

chronic kidney disease – densitometry – fractures

Sources
  1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcomes Quality Initiative. Am J Kidney Dis 2002; 2(Suppl 1): S1–S266.
  2. Hruska KA, Seifert M, Sugatani T. Pathophysiology of the chronic kidney disease-mineral bone disorder. Curr Opin Nephrol Hypertens 2015; 24(4): 303–309. Dostupné z DOI: <http://dx.doi.org/10.1097/MNH.0000000000000132>.
  3. Kraut JA, Madias NE. Metabolic Acidosis of CKD: An Update. Am J Kidney Dis 2016; 67(2): 307–317. Dostupné z DOI: <http://dx.doi.org/10.1053/j.ajkd.2015.08.028>.
  4. Malluche HH, Ritz E, Lange HP et al. Bone histology in incipient and advanced renal failure. Kidney Int 1976; 9(4): 355–362. Dostupné z DOI: <http://dx.doi.org/10.1038/ki.1976.42>.
  5. Moe S, Drueke T, Cunningham J et al. Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69(11): 1945–1953. Dostupné z DOI: <http://dx.doi.org/10.1038/sj.ki.5000414
  6. Dusilová Sulková S (ed). Renální osteopatie. Maxdorf: Praha 2007: 21–23. ISBN 978–80–7345–119–6.
  7. Bover J, Ureña-Torres P, Torregrosa JV et al. Osteoporosis, bone mineral density and CKD-MBD complex (I): Diagnostic considerations. Nefrologia 2018; 38(5): 476–490. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nefro.2017.12.006>.
  8. Khairallah P, Nickolas TL. Management of Osteoporosis in CKD. Clin J Am Soc Nephrol 2018; 13(6): 962–969. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.11031017>.
  9. Brunerová L. Osteoporóza u pacientů s pokročilou renální insuficiencí – jak ji diagnostikovat a léčit? Osteol Bull 2016; 21(4): 119–123.
  10. Brunerová L, Ronová P, Verešová J et al. Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients. Kidney Blood Press Res 2016; 41(3): 345–354. Dostupné z DOI: <http://dx.doi.org/10.1159/000443439>.
  11. Malluche HH, Davenport DL, Cantor T et al. Bone mineral density and serum biochemical predictors of bone loss in patients with CKD on dialysis. Clin J Am Soc Nephrol 2014; 9(7): 1254–1262. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.09470913>.
  12. Bezerra de Carvalho KS, Vasco RF, Custodio MR et al. Chronic kidney disease is associated with low BMD at the hip but not at the spine. Osteoporos Int 2019; 30(5): 1015–1023. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198–019–04864–4>.
  13. Moe SM, Nickolas TL. Fractures in Patients with CKD: Time for Action..Clin J Am Soc Nephrol 2016; 11(11): 1929–1931. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.09500916>.
  14. Pimentel A, Ureña-Torres P, Zillikens MC et al. Fractures in patients with CKD-diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation. Kidney Int 2017; 92(6): 1343–1355. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kint.2017.07.021>.
  15. Alem AM, Sherrard DJ, Gillen DL et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 2000; 58(1): 396–399. Dostupné z DOI: <http://dx.doi.org/10.1046/j.1523–1755.2000.00178.x>.
  16. Salam SN, Eastell R, Khwaja A. Fragility fractures and osteoporosis in CKD: Pathophysiology and Diagnostic Methods. Am J Kidney Dis 2014; 63(6): 2049–2059. Dostupné z DOI: <http://dx.doi.org/10.1053/j.ajkd.2013.12.016>.
  17. Bucur RC, Panjwani DD, Turner L et al. Low bone mineral density and fractures in stages 3–5 CKD: an updated systematic review and meta-analysis. Osteoporos Int 2015; 26(2): 449–458. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198–014–2813–3>.
  18. Beaubrun AC, Kilpatrick RD, Freburger JK et al. Temporal trends in fracture rates and postdischarge outcomes among hemodialysis patients. J Am Soc Nephrol 2013; 24(9): 1461–1469. Dostupné z DOI: <http://dx.doi.org/10.1681/ASN.2012090916>.
  19. Kim SM, Long J, Montez-Rath M et al. Hip fracture in patients ith non-dialysis-requiring chronic kidney disease. J Bone Miner Res 2016; 31(10): 1803–1809. Dostupné z DOI: <http://dx.doi.org/10.1002/jbmr.2862>.
  20. Robertson L, Black C, Fluck N et al. Hip fracture incidence and mortality in chronic kidney disease: the GLOMMS-II record linkage cohort study. BMJ Open 2018; 8(4): e020312. Dostupné z DOI: <http://dx.doi.org/10.1136/bmjopen-2017–020312>.
  21. [Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group]. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009; 76(113): S1-S130. Dostupné z DOI: <http://dx.doi.org/10.1038/ki.2009.188>.
  22. Fried LF, Biggs ML, Shlipak MG et al. Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol 2007; 18(1): 282–286. Dostupné z DOI: <http://dx.doi.org/10.1681/ASN.2006050546>.
  23. Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int 2008; 74(6): 721–731. Dostupné z DOI: <http://dx.doi.org/10.1038/ki.2008.264>.
  24. Miller PD. Chronic kidney disease and osteoporosis: evaluation and management. Bonekey Rep 2014; 3: 542. Dostupné z DOI: <http://dx.doi.org/10.1038/bonekey.2014.37>.
  25. Iimori S, Mori Y, Akita W et al. Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients – a single-centre cohort study. Nephrol Dial Transplant 2012; 27(1): 345–351. Dostupné z DOI: <http://dx.doi.org/10.1093/ndt/gfr317>.
  26. West SL, Lok CE, Langsetmo L et al. Bone mineral density predicts fractures in chronic kidney disease. J Bone Miner Res 2015; 30(5): 913–919. Dostupné z DOI: <http://dx.doi.org/10.1002/jbmr.2406>.
  27. Adragao T, Herberth J, Monier-Faugere MC et al. Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients. Osteoporos Int 2010; 21(4): 619–625. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198–009–0988–9>.
  28. Blomquist GA, Davenport DL, Mawad HW et al. Diagnosis of low bone mass in CKD-5D patients. Clin Nephrol 2016; 85(2): 77–83. Dostupné z DOI: <http://dx.doi.org/10.5414/CN108708>.
  29. Salam S, Gallagher O, Gossiel F et al. Diagnostic Accuracy of Biomarkers and Imaging for Bone Turnover in Renal Osteodystrophy. Am Soc Nephrol 2018; 29(5): 1557–1565. Dostupné z DOI: <http://dx.doi.org/10.1681/ASN.2017050584>.
  30. Sprague SM, Bellorin-Font E, Jorgetti V et al. Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysis. Am J Kidney Dis 2016; 67(4): 559–566. Dostupné z DOI: <http://dx.doi.org/10.1053/j.ajkd.2015.06.023>.
  31. Wilson LM, Rebholz CM, Jirru E et al. Benefits and Harms of Osteoporosis Medications in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. Ann Intern Med 2017; 166(9): 649–658. Dostupné z DOI: <http://dx.doi.org/10.7326/M16–2752>.
  32. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2017; (7): 1–59. Dostupné z WWW: <https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf>.
  33. Brunerova L, Palicka V, Sulkova SD. Commentary on management of osteoporosis in advanced CKD: common view of a nephrologist and a bone specialist. Endocr Pract 2019; 25(2): 193–196. Dostupné z DOI: <http://dx.doi.org/10.4158/EP-2018–0311>.
  34. Moe SM. Renal Osteodystrophy or Kidney-Induced Osteoporosis? Curr Osteoporos Rep 2017; 15(3): 194–197. <http://dx.doi.org/10.1007/s11914–017–0364–1>.
  35. Carvalho C, Magalhães J, Neto R et al.Cortical bone analysis in a predialysis population: a comparison with a dialysis population. J Bone Miner Metab 2017; 35(5): 513–521. Dostupné z DOI: <http://dx.doi.org/10.1007/s00774–016–0781–8>.
  36. Nickolas TL, Stein EM, Dworakowski E et al. Rapid cortical bone loss in patients with chronic kidney disease. J Bone Miner Res 2013; 28(8): 1811–1820. Dostupné z DOI: <http://dx.doi.org/10.1002/jbmr.1916>.
  37. Malluche HH, Monier-Faugere MC, Blomquist G et al.Two-year cortical and trabecular bone loss in CKD-5D: biochemical and clinical predictors. Osteoporos Int 2018; 29(1): 125–134. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198–017–4228–4>.
  38. Bezerra de Carvalho KS, Vasco RFV, Custodio MR et al. Chronic kidney disease is associated with low BMD at the hip but not at the spine. Osteoporos Int 2019; 30(5): 1015–1023. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198–019–04864–4>.
  39. London GM, Marty C, Marchais SJ et al. Arterial calcifications and bone histomorphometry in endstage renal disease. J Am Soc Nephrol 2004; 15(7): 1943–1951. Dostupné z DOI: <http://dx.doi.org/10.1097/01.asn.0000129337.50739.48>.
  40. Toussaint ND, Lau KK, Strauss BJ et al. Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease. Nephrol Dial Transplant 2008; 23(2): 586–593. Dostupné z DOI: <http://dx.doi.org/10.1093/ndt/gfm660>.
  41. Orlic L, Crncevic Z, Pavlovic D et al. Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure. Ren Fail 2010; 32(3): 300–308. Dostupné z DOI: <http://dx.doi.org/10.3109/08860221003611661>.
  42. Orlic L, Mikolasevic I, Crncevic-Orlic Z et al. Forearm bone mass predicts mortality in chronic haemodialysis patients. J Bone Miner Metab 2017; 35(4): 396–404. Dostupné z DOI:<http://dx.doi.org/10.1007/s00774–016–0766–7>.
  43. Toussaint ND, Lau KK, Strauss BJ et al. Using vertebral bone densitometry to determine aortic calcification in patients with chronic kidney disease. Nephrology (Carlton) 2010; 15(5): 575–583. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1440–1797.2010.01288.x>.
  44. Bover J, Górriz JL, Ureña-Torres P et al et al. Detection of cardiovascular calcifications: Is it a useful tool for nephrologists? Nefrologia 2016; 36(6): 587–596. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nefro.2016.05.021>.
  45. von der Recke P, Hansen MA, Hassager C. The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 1999; 106: 273–278. Dostupné z DOI: <http://dx.doi.org/10.1016/s0002–9343(99)00028–5>.
  46. Tanko LB, Christiansen C, Cox DA et al. Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 2005; 20(11): 1912–1920. Dostupné z DOI: <http://dx.doi.org/10.1359/JBMR.050711>.
  47. Banks LM, Lees B, MacSweeney JE et al. Effect of degenerative spinal and aortic calcification on bone density measurements in post-menopausal women: Links between osteoporosis and cardiovascular disease? Eur J Clin Invest 1994; 24(12): 813–817. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2362.1994.tb02024.x>.
  48. Moe SM. Vascular calcification and renal osteodystrophy relationship in chronic kidney disease. Eur J Clin Invest 2006; 36(Suppl 2): 2S51–2S62. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2362.2006.01665.x>.
  49. Schousboe JT, Wilson KE, Kiel DP. Detection of abdominal aortic calcification with lateral spine imaging using DXA. J Clin Densitom 2006; 9(3): 302–308. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jocd.2006.05.007>.
  50. Kauppila LI, Polak JF, Cupples LA et al. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: A 25-year follow-up study. Atherosclerosis 1997; 132(2): 245–250. Dostupné z DOI: <http://dx.doi.org/10.1016/s0021–9150(97)00106–8>.
  51. Schousboe JT, Wilson KE, Hangartner TN. Detection of aortic calcification during vertebral fracture assessment (VFA) compared to digital radiography. PLoS ONE 2007; 2(8):e715. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0000715>.
  52. Aleksova J, Kurniawan S, Elder GJ. The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease. Osteoporos Int 2018; 29(6): 1447–1455. Dostupné z DOI: <https://link.springer.com/article/10.1007%2Fs00198-018-4468-y>.
Labels
Clinical biochemistry Paediatric gynaecology Paediatric radiology Paediatric rheumatology Endocrinology Gynaecology and obstetrics Internal medicine Orthopaedics General practitioner for adults Radiodiagnostics Rehabilitation Rheumatology Traumatology Osteology
Background theses for the formulation of guidelines on diagnosis and therapy metabolic bone disease as a part of CKD-MBD, with specific focus on low mineral bone content in DXA examination
Association between bone and vascular calcification: evidence from clinical studies
Bone disease in patients after organ transplantation
Calciphylaxis as a multidisciplinary problem: important information (not only) for clinical osteologists and case reports
ODPORÚČANIE SOMOK DLHODOBÁ LIEČBA OSTEOPORÓZY DENOSUMABOM
První biosimilár k léčbě osteoporózy v EU schválen!
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