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How to predict and treat increased fracture risk in chronic kidney disease
Author(s) -
West S. L.,
Patel P.,
Jamal S. A.
Publication year - 2015
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12361
Subject(s) - medicine , kidney disease , bone remodeling , bone mineral , randomized controlled trial , renal function , intensive care medicine , surgery , osteoporosis
Men and women with chronic kidney disease ( CKD ) are at an increased risk of fracture, and this risk increases as kidney function deteriorates. Fractures are associated with morbidity, mortality and economic costs. Despite this, there is a paucity of data regarding how to evaluate risk for fractures in CKD and how to treat high‐risk patients. Evidence suggests that bone mineral density ( BMD ) as assessed by dual‐energy X ‐ray absorptiometry ( DXA ) is associated with fractures and can also predict future fractures in predialysis (stages 1–3) patients with CKD . In the absence of considerable abnormalities in markers of mineral metabolism, treatment with antiresorptive agents in men and women with early CKD at high fracture risk may be appropriate. Of note, recent data suggest that low BMD as measured by DXA can also predict fractures in patients with more advanced CKD (stages 4, 5 and 5 D ). However, treatment in patients with advanced CKD requires bone biopsy, the gold standard to assess bone turnover, prior to treatment. Further research, focusing on noninvasive methods to assess fracture risk and bone turnover, together with randomized controlled trials of treatments to reduce fractures in patients at all stages of CKD , is required.