Fusaro Maria, Aghi Andrea, Mereu Maria Cristina, Giusti Andrea
Consiglio Nazionale delle Ricerche (CNR) - Istituto di Fisiologia Clinica (IFC), Pisa e Dipartimento di Medicina, Università di Padova.
Dipartimento di Medicina, Università degli Studi di Padova.
G Ital Nefrol. 2017 Dec 5;34(Nov-Dec):2017-vol6.
Fragility fractures (FF) are common in patients with chronic kidney disease (CKD), and they occur at a younger age and with a higher frequency than in the general population, producing significant morbidity, mortality and healthcare costs. The pathogenic mechanisms underlying FF in CKD patients have not been completely understood. Behind CKD-MBD, the uremic toxicity should play a role in their pathogenesis, by affecting bone quality (uremic osteoporosis). There are very few prospective studies investigating risk factors for fragility fractures in CKD patients, and available algorithms for fracture risk prediction (FRAX and DeFRA) have never considered CKD. The diagnosis of vertebral fractures (FV), under-diagnosed in CKD patients as well as in general population, should be performed by Quantitative Vertebral Morphometry (QVM) both with DXA or Spine (D4-L5) x-Ray. A recent KDIGO review has qualified the measurement of the Bone Mineral Density by DXA as a predictive tool for fracture risk assessment in patients with stage G3a-G5D. Furthermore, the Trabecular Bone Score (TBS, software applied to DXA) allows the bone quality evaluation as well as the fracture risk prediction. Other techniques, such as Quantitative Computerized Tomography (QCT), especially High Resolution-peripheral QCT (HR-pQCT), have been shown to be useful, although expensive. Finally, some bone biomarkers (PTH and BAP) demonstrated to be informative for the definition of fracture risk in patients with CKD-MBD. In conclusion, there are several different tools and approaches that demonstrated to be useful for the identification of CKD patients at high risk of fracture, when these are appropriately performed and interpreted by expertise clinicians.
脆性骨折（FF）在慢性肾脏病（CKD）患者中很常见，其发生年龄比普通人群更年轻，频率更高，会导致显著的发病率、死亡率和医疗费用。CKD患者发生FF的致病机制尚未完全明确。在CKD - 矿物质和骨异常（CKD - MBD）背后，尿毒症毒性可能通过影响骨质量（尿毒症性骨质疏松）在其发病机制中起作用。很少有前瞻性研究调查CKD患者脆性骨折的危险因素，现有的骨折风险预测算法（FRAX和DeFRA）从未考虑过CKD。椎体骨折（FV）的诊断在CKD患者以及普通人群中都存在漏诊情况，应通过双能X线吸收法（DXA）或脊柱（D4 - L5）X线进行定量椎体形态测量（QVM）来诊断。最近KDIGO的一项综述将DXA测量骨密度定性为G3a - G5D期患者骨折风险评估的预测工具。此外，骨小梁骨评分（TBS，应用于DXA的软件）可用于评估骨质量以及预测骨折风险。其他技术，如定量计算机断层扫描（QCT），尤其是高分辨率外周QCT（HR - pQCT），已被证明是有用的，尽管成本较高。最后，一些骨生物标志物（甲状旁腺激素和骨碱性磷酸酶）已被证明对定义CKD - MBD患者的骨折风险具有参考价值。总之，当由专业临床医生进行适当操作和解读时，有几种不同的工具和方法已被证明对识别骨折高危CKD患者是有用的。
