Toussaint Nigel D, Elder Grahame J, Kerr Peter G
Department of Nephrology, Monash Medical Centre and Monash University, Clayton, Vic., Australia.
Semin Dial. 2010 Jan-Feb;23(1):43-54. doi: 10.1111/j.1525-139X.2009.00650.x.
Extrapolation of evidence-based management of disorders in the general population to patients with chronic kidney disease (CKD) is not always appropriate, and the prevention of bone fracture and reduction of fracture risk in CKD stages 3-5 is one example. Compared to the general population, fracture risk is greater in CKD patients, especially those on dialysis (CKD-5D). Fractures in CKD-5D are associated with a marked increase in morbidity and mortality and with an aging dialysis population the burden of disease caused by fracture is likely to increase. Patients with CKD-5D have distinct risks for fracture, as well as sharing risks identified in the general population. The development of the CKD mineral and bone disorder constitutes a significant cause for these differences. Literature addressing the determination of fracture risk and the efficacy of treatments to reduce fracture in patients on dialysis is limited. While some tools used for the diagnosis and monitoring of osteoporosis are applicable to patients on dialysis, bone mineral density measurement by dual-energy X-ray absorptiometry is generally not helpful and therapeutic interventions that reduce fracture risk in the nonuremic population cannot be generalized to patients on dialysis. This review outlines available evidence on the incidence, risk factors, and management of fractures in CKD-5D with recommendations for strategies to reduce fracture risk.
将普通人群中疾病的循证管理方法外推至慢性肾脏病（CKD）患者并不总是合适的，CKD 3-5期患者预防骨折及降低骨折风险就是一个例子。与普通人群相比，CKD患者的骨折风险更高，尤其是接受透析的患者（CKD-5D）。CKD-5D患者发生骨折与发病率和死亡率显著增加相关，且随着透析人群老龄化，骨折所致疾病负担可能会增加。CKD-5D患者除了具有普通人群中已明确的骨折风险外，还有其独特的骨折风险。CKD矿物质和骨异常的发生是造成这些差异的一个重要原因。关于透析患者骨折风险评估及降低骨折风险治疗效果的文献有限。虽然一些用于诊断和监测骨质疏松症的工具适用于透析患者，但双能X线吸收法测量骨密度通常并无帮助，且非尿毒症人群中降低骨折风险的治疗干预措施不能推广至透析患者。本综述概述了CKD-5D患者骨折的发生率、危险因素及管理方面的现有证据，并对降低骨折风险的策略提出了建议。
