Department of Nephrology, KU Leuven University Hospitals Leuven, Leuven, Belgium.
Centre for Nephrology, UCL Medical School, Royal Free Campus, London, UK.
Nephrol Dial Transplant. 2021 Jan 1;36(1):42-59. doi: 10.1093/ndt/gfaa192.
Controlling the excessive fracture burden in patients with chronic kidney disease (CKD) Stages G4-G5D remains an impressive challenge. The reasons are 2-fold. First, the pathophysiology of bone fragility in patients with CKD G4-G5D is complex and multifaceted, comprising a mixture of age-related (primary male/postmenopausal), drug-induced and CKD-related bone abnormalities. Second, our current armamentarium of osteoporosis medications has not been developed for, or adequately studied in patients with CKD G4-G5D, partly related to difficulties in diagnosing osteoporosis in this specific setting and fear of complications. Doubts about the optimal diagnostic and therapeutic approach fuel inertia in daily clinical practice. The scope of the present consensus paper is to review and update the assessment and diagnosis of osteoporosis in patients with CKD G4-G5D and to discuss the therapeutic interventions available and the manner in which these can be used to develop management strategies for the prevention of fragility fracture. As such, it aims to stimulate a cohesive approach to the management of osteoporosis in patients with CKD G4-G5D to replace current variations in care and treatment nihilism.
控制慢性肾脏病（CKD）G4-G5D 期患者的过度骨折负担仍然是一个巨大的挑战。原因有两个。首先，CKD G4-G5D 患者的骨脆弱的病理生理学是复杂和多方面的，包括与年龄相关的（原发性男性/绝经后）、药物诱导和 CKD 相关的骨异常的混合。其次，我们目前用于骨质疏松症的药物武器库并非专为 CKD G4-G5D 患者开发，也未在该人群中进行充分研究，部分原因是在这种特定环境中诊断骨质疏松症存在困难，且担心并发症。对最佳诊断和治疗方法的疑虑导致日常临床实践中的惰性。本共识文件的范围是审查和更新 CKD G4-G5D 患者骨质疏松症的评估和诊断，并讨论可用的治疗干预措施以及如何利用这些措施制定预防脆性骨折的管理策略。因此，它旨在为 CKD G4-G5D 患者的骨质疏松症管理激发一种协调一致的方法，以取代当前护理和治疗虚无主义的差异。
