Chapter 17 Osteoporosis, bone fragility, and renal osteodystrophy in chronic kidney disease
Brian Camilleri and
Gavin Clunie
- • Renal osteodystrophy is defined as an alteration in bone morphology in patients with chronic kidney disease.
- • Abnormalities in bone turnover prevail in renal osteodystrophy, with high turnover disease due to secondary or tertiary hyperparathyroidism at one end of the spectrum and low turnover disease such as adynamic bone disease and osteomalacia at the other end.
- • Renal osteodystrophy is an important cause of morbidity, decreased quality of life, and an increased risk of fractures.
- • With more advanced stages of chronic kidney disease, management focuses on maintaining optimal levels of phosphorus, calcium, and PTH.
- • Osteoporosis in chronic kidney disease stages 1–3 is managed as in the general population. The situations with stages 4 and 5 remain uncertain owing to lack of fracture end-point studies.
- • There is an increased risk of fractures after renal trans- plantation. This is mainly related to glucocorticoid use.
