Ramsay-Générale de Santé, Clinique du Landy, Saint-Ouen, France.
Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France.
J Nephrol. 2017 Oct;30(5):653-661. doi: 10.1007/s40620-017-0398-6. Epub 2017 Apr 6.
Chronic kidney disease (CKD) is associated with mineral and bone disorders (MBD) that are now considered as a syndrome. Bone fragility and a four to tenfold increased rate of skeletal fractures are often reported in CKD patients. The evaluation of the risk of these fractures in CKD patients should explore the same risk factors identified for the general population including low body weight, menopause, personal and familial history of osteoporosis, chronic inflammatory diseases, and corticosteroid therapy. The aim of this article is to provide a critical review of the tools used for the evaluation of bone loss and the risk of fracture in CKD patients, ranging from the measurement of bone mineral density (BMD), fracture risk assessment (Frax™), quantitative computed tomography (QCT), high-resolution peripheral quantitative computed tomography (HRpQTC), to circulating biomarkers of bone metabolism including vitamin D, parathyroid hormone (PTH), bone-specific alkaline phosphatase, osteocalcin, and some collagen type 1-related molecules indicators of bone remodeling.
慢性肾脏病（CKD）与矿物质和骨代谢紊乱（MBD）相关，目前被认为是一种综合征。CKD 患者常报告骨脆性和骨折风险增加 4 至 10 倍。在 CKD 患者中评估这些骨折的风险时，应探讨与一般人群相同的风险因素，包括低体重、绝经、骨质疏松症个人和家族史、慢性炎症性疾病和皮质类固醇治疗。本文的目的是对用于评估 CKD 患者骨丢失和骨折风险的工具进行批判性回顾，这些工具包括骨矿物质密度（BMD）测量、骨折风险评估（Frax™）、定量计算机断层扫描（QCT）、高分辨率外周定量计算机断层扫描（HRpQTC）、以及骨代谢的循环生物标志物，包括维生素 D、甲状旁腺激素（PTH）、骨特异性碱性磷酸酶、骨钙素和一些胶原 1 型相关分子，这些标志物反映了骨重塑。
