Lloret Maria J, Fusaro Maria, Jørgensen Hanne S, Haarhaus Mathias, Gifre Laia, Alfieri Carlo M, Massó Elisabet, D'Marco Luis, Evenepoel Pieter, Bover Jordi
Nephrology Department, Fundació Puigvert, Cartagena 340-350, 08025 Barcelona, Spain.
Institut de Recerca Sant Pau (IR-Sant-Pau), 08025 Barcelona, Spain.
J Clin Med. 2024 Feb 9;13(4):1010. doi: 10.3390/jcm13041010.
Bone strength is determined not only by bone quantity [bone mineral density (BMD)] but also by bone quality, including matrix composition, collagen fiber arrangement, microarchitecture, geometry, mineralization, and bone turnover, among others. These aspects influence elasticity, the load-bearing and repair capacity of bone, and microcrack propagation and are thus key to fractures and their avoidance. In chronic kidney disease (CKD)-associated osteoporosis, factors traditionally associated with a lower bone mass (advanced age or hypogonadism) often coexist with non-traditional factors specific to CKD (uremic toxins or renal osteodystrophy, among others), which will have an impact on bone quality. The gold standard for measuring BMD is dual-energy X-ray absorptiometry, which is widely accepted in the general population and is also capable of predicting fracture risk in CKD. Nevertheless, a significant number of fractures occur in the absence of densitometric World Health Organization (WHO) criteria for osteoporosis, suggesting that methods that also evaluate bone quality need to be considered in order to achieve a comprehensive assessment of fracture risk. The techniques for measuring bone quality are limited by their high cost or invasive nature, which has prevented their implementation in clinical practice. A bone biopsy, high-resolution peripheral quantitative computed tomography, and impact microindentation are some of the methods established to assess bone quality. Herein, we review the current evidence in the literature with the aim of exploring the factors that affect both bone quality and bone quantity in CKD and describing available techniques to assess them.
骨强度不仅取决于骨量[骨矿物质密度（BMD）]，还取决于骨质量，包括基质组成、胶原纤维排列、微观结构、几何形状、矿化以及骨转换等。这些方面会影响骨的弹性、承重和修复能力，以及微裂纹的扩展，因此是骨折及其预防的关键。在慢性肾脏病（CKD）相关的骨质疏松症中，传统上与较低骨量相关的因素（高龄或性腺功能减退）常常与CKD特有的非传统因素（如尿毒症毒素或肾性骨营养不良等）并存，这些因素会对骨质量产生影响。测量BMD的金标准是双能X线吸收法，该方法在普通人群中被广泛接受，并且也能够预测CKD患者的骨折风险。然而，相当一部分骨折发生在不符合世界卫生组织（WHO）骨质疏松症密度测定标准的情况下，这表明为了全面评估骨折风险，需要考虑同时评估骨质量的方法。测量骨质量的技术因其高成本或侵入性而受到限制，这阻碍了它们在临床实践中的应用。骨活检、高分辨率外周定量计算机断层扫描和冲击微压痕是一些已确立的评估骨质量的方法。在此，我们回顾文献中的现有证据，旨在探讨影响CKD患者骨质量和骨量的因素，并描述评估这些因素的可用技术。
