Andress D L
Division of Nephrology, University of Washington, Seattle, Washington, USA.
Kidney Int. 2008 Jun;73(12):1345-54. doi: 10.1038/ki.2008.60. Epub 2008 Mar 12.
Adynamic bone in patients with chronic kidney disease (CKD) is a clinical concern because of its potential increased risk for fracture and cardiovascular disease (CVD). Prevalence rates for adynamic bone are reportedly increased, although the variance for its prevalence and incidence is large. Differences in its prevalence are largely attributed to classification and population differences, the latter of which constitutes divergent groups of elderly patients having diabetes and other comorbidities that are prone to low bone formation. Most patients have vitamin D deficiency and the active form, 1,25-dihydroxyvitamin D, invariably decreases to very low levels during CKD progression. Fortunately, therapy with vitamin D receptor activators (VDRAs) appears to be useful in preventing bone loss, in part, by its effect to stimulate bone formation and in decreasing CVD morbidity, and should be considered as essential therapy regardless of bone turnover status. Future studies will depend on assessing cardiovascular outcomes to determine whether the risk/reward profile for complications related to VDRA and CKD is tolerable.
慢性肾脏病（CKD）患者的动力缺乏性骨病是一个临床关注点，因为其存在骨折和心血管疾病（CVD）风险增加的潜在可能。据报道，动力缺乏性骨病的患病率有所上升，尽管其患病率和发病率的差异很大。患病率的差异很大程度上归因于分类和人群差异，后者包括患有糖尿病和其他易导致低骨形成合并症的不同老年患者群体。大多数患者存在维生素D缺乏，在CKD进展过程中，其活性形式1,25 - 二羟维生素D总是会降至非常低的水平。幸运的是，维生素D受体激活剂（VDRAs）治疗似乎有助于预防骨质流失，部分原因是其刺激骨形成的作用以及降低CVD发病率，并且无论骨转换状态如何，都应被视为基本治疗方法。未来的研究将依赖于评估心血管结局，以确定与VDRAs和CKD相关并发症的风险/获益情况是否可接受。
