Chronic Kidney Disease and Bone Health
Summary
Chronic kidney disease affects one in ten people worldwide and impairs the body’s control of calcium, phosphate, vitamin D and parathyroid hormone. These imbalances lead to chronic kidney disease–mineral and bone disorder (CKD–MBD), characterised by abnormalities in bone turnover, mineralisation, volume and strength, as well as extraskeletal calcification. Early in renal decline, patients may develop high‐turnover bone disease driven by secondary hyperparathyroidism or progress to low‐turnover, adynamic bone disease. Both conditions increase the risk of fragility fractures, which carry substantial morbidity and mortality. Assessment combines dual‐energy X‐ray absorptiometry (DXA) to estimate bone mineral density with circulating biomarkers of bone formation and resorption, although altered clearance in kidney impairment can complicate interpretation. Management integrates lifestyle measures—exercise, optimal nutrition, smoking cessation—with correction of mineral imbalances through phosphate control and vitamin D supplementation, followed by patient-centred use of antiresorptive or anabolic therapies. As ageing and metabolic disease drive a growing CKD burden, refined diagnostic tools and tailored interventions are essential to preserve bone health and reduce fracture-related complications.
Research from Nature Portfolio
A prospective cohort study compared denosumab therapy in patients on haemodialysis with those retaining renal function. Both groups experienced comparable annual increases in bone mineral density at the lumbar spine and femoral neck, confirming the agent’s efficacy regardless of dialysis status. However, hypocalcaemia was significantly more common and occurred earlier among haemodialysis recipients, underscoring the need for rigorous calcium monitoring and supplementation during the initial month of treatment. These findings support denosumab as a viable option for bone strengthening in advanced CKD, provided mineral homeostasis is closely managed.
Chronic Kidney Disease and Bone Health publication trend
The graph below shows the total number of articles in chronic kidney disease and bone health across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic kidney disease–mineral and bone disorder (CKD–MBD): A systemic disturbance of mineral metabolism and bone remodelling caused by impaired kidney function.
Renal osteodystrophy: The spectrum of bone pathology that arises within CKD–MBD, defined by specific histological patterns.
Adynamic bone disease: A subtype of renal osteodystrophy characterised by low bone turnover and reduced cellular activity.
Bone mineral density (BMD): A quantitative measure of bone strength, typically assessed by dual-energy X-ray absorptiometry.
Dual-energy X-ray absorptiometry (DXA): An imaging modality that uses two X-ray beams to calculate BMD.
Fracture risk assessment tool (FRAX): An algorithm combining clinical risk factors and BMD to estimate the 10-year probability of fractures.
Antiresorptive agent: A class of drugs (e.g. bisphosphonates, denosumab) that inhibit osteoclast-mediated bone resorption.
Anabolic agent: A therapy that promotes osteoblast-driven bone formation.
Hypocalcaemia: A clinical condition defined by abnormally low serum calcium concentrations.
Denosumab: A monoclonal antibody targeting RANK ligand to decrease osteoclast activity and bone resorption.
References
- Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review. International Journal of Molecular Sciences (2020).
- Circulating markers of bone turnover. Journal of Nephrology (2017).
- Denosumab for dialysis patients with osteoporosis: A cohort study. Scientific Reports (2020).
- Safety of Oral Bisphosphonates in Moderate‐to‐Severe Chronic Kidney Disease: A Binational Cohort Analysis. Journal of Bone and Mineral Research (2020).
- Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment. Kidney International (2021).
About these summaries
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