Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action

Author:

Gifre Laia1ORCID,Massó Elisabet2,Fusaro Maria3ORCID,Haarhaus Mathias45ORCID,Ureña Pablo67,Cozzolino Mario8ORCID,Mazzaferro Sandro9ORCID,Calabia Jordi10,Peris Pilar11,Bover Jordi2

Affiliation:

1. Rheumatology Department, Hospital Germans Trias i Pujol, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona ( Barcelona), Catalonia , Spain

2. Nephrology Department, University Hospital Germans Trias i Pujol, REMAR-IGTP Group, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona ( Barcelona), Catalonia , Spain

3. National Research Council (CNR), Institute of Clinical Physiology, Pisa (Italy). Department of Medicine, University of Padua, Padua , Italy

4. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital , Huddinge, Stockholm , Sweden

5. Diaverum AB , Hyllie Boulevard 53, Malmö , Sweden

6. Department of Nephrology and Dialysis, AURA Nord Saint-Ouen, Saint-Ouen , Paris , France

7. Department of Renal Physiology, Necker Hospital, University of Paris Descartes , Paris , France

8. Renal Division, Department of Health Sciences, University of Milan, Milan , Italy

9. Department of Translation and Precision Medicine, Sapienza University of Rome , Rome , Italy

10. Nephrology Department, University Hospital Josep Trueta. IdIBGi Research Institute. Universitat de Girona , Catalonia , Spain

11. Rheumatology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona , Barcelona, Catalonia , Spain

Abstract

ABSTRACT Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life, and high risk of subsequent fractures, especially when recent, multiple, or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1–G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density, diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of bone mineral density in 2017 after the publication of the CKD-Mineral and Bone Disorder Kidney Disease: Improving Global Outcomes guidelines. A proactive attitude towards diagnosis, treatment, and research is proposed to avoid therapeutic nihilism.

Publisher

Oxford University Press (OUP)

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