López Oliva María Ovidia, Del Castillo Caba Domingo, Sánchez Plumed Jaime
Servicio de Nefrología, Hospital La Paz, Madrid.
Nefrologia. 2009;29 Suppl 1:31-7. doi: 10.3265/NEFROLOGIA.2009.29.S.1.5635.EN.FULL.
Recently, the Foundation has proposed new definitions KDIGO to refer to the alterations of bone - mineral metabolism in patients with chronic renal disease (CRD), relegating the traditional term of renal osteodystrophy (ODR). RECOMMEND: The term ODR exclusively to define alterations in bone morphology and architecture characteristic of the ERC. - And the term of bone-mineral alteration associated with the CRD to describe biochemical changes, and skeletal calcifications that occur as a result of alterations in mineral metabolism in the CRD.
The different metabolic abnormalities are secondary to the progressive loss of renal mass and renal function that leads to retention of phosphorus and a decrease in the levels of calcitriol which are responsible for the skeletal resistance to the action of PTH.
The main clinical manifestations of abnormal bone mineral metabolism are posttransplantation osteoporosis and osteopenia producing an increase in fractures, osteonecrosis, and bone pain.
Biochemical parameters (calcium, phosphorus, PTH, 25 hydroxyvitamin D), X-ray bone densitometry and bone biopsy. (Evidence B). THERAPEUTIC ALTERNATIVES: It is recommended for the treatment and prevention of osteopenia - osteoporosis in transplant patients based on data from clinical evidence available from other study populations, such as in patients with chronic kidney disease. In addition to specific treatment, we must take into account the preventive measures to reduce the risk of fractures. Treatment includes specific measures for the prevention of bone loss (active metabolite of vitamin D analogues and bisphosphonates) and the treatment of persistent hyperparathyroidism (calcimiméticos). (Evidence B).
最近，该基金会提出了KDIGO的新定义，用于指代慢性肾病（CRD）患者骨矿物质代谢的改变，摒弃了传统的肾性骨营养不良（ODR）术语。
仅用ODR一词来定义ERC特有的骨形态和结构改变。
——并用与CRD相关的骨矿物质改变这一术语来描述生化变化以及CRD中矿物质代谢改变导致的骨骼钙化。
不同的代谢异常继发于肾实质和肾功能的渐进性丧失，这会导致磷潴留以及骨化三醇水平降低，而骨化三醇负责骨骼对甲状旁腺激素作用的抵抗。
骨矿物质代谢异常的主要临床表现是移植后骨质疏松和骨质减少，导致骨折、骨坏死和骨痛增加。
生化参数（钙、磷、甲状旁腺激素、25-羟基维生素D）、X线骨密度测定和骨活检。（证据B）
根据来自其他研究群体（如慢性肾病患者）的临床证据数据，建议对移植患者的骨质减少-骨质疏松进行治疗和预防。除了特定治疗外，我们必须考虑采取预防措施以降低骨折风险。治疗包括预防骨质流失的特定措施（维生素D类似物的活性代谢物和双膦酸盐）以及持续性甲状旁腺功能亢进的治疗（拟钙剂）。（证据B）
