Laurent Michaël R, Dupont Jolan, Lemahieu Wim, Jamar Sofie, Mellaerts Bea, Dejaeger Marian, Gielen Evelien, Evenepoel Pieter
Geriatrics Department, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium.
Centre for Metabolic Bone Diseases, University Hospitals Leuven, Louvain, Belgium.
Curr Osteoporos Rep. 2025 Jun 2;23(1):26. doi: 10.1007/s11914-025-00919-0.
To discuss current evidence on the diagnosis and management of osteoporosis in patients with chronic kidney disease (CKD).
Osteoporosis and fractures are prevalent in older CKD patients and associated with poor process indicators and outcomes. While osteoporosis treatment is generally similar in patients without or with CKD up to stage 3, there is still a lack of evidence to guide many areas of osteoporosis management in CKD stages 4-5. There is an urgent need to establish local multidisciplinary care pathways for CKD and dialysis patients with osteoporosis, involving nephrologists, bone specialists and fracture liaison services. Optimization of calcium and vitamin D metabolism and non-pharmacological measures including exercise and falls prevention should be considered in all patients. Withholding bone drugs solely based on glomerular filtration rates may constitute renalism (discrimination based on kidney function), which would further widen the already large treatment gap in osteoporosis. On the other hand, more evidence is needed to inform almost every aspect of anti-osteoporotic pharmacotherapy in CKD stages 4-5. The concept of choosing between antiresorptive or anabolic bone drugs based on a pre-treatment assessment of bone turnover (using biomarkers or bone biopsies), is a dogma in urgent need of critical re-evaluation. This narrative review aims to summarize our current understanding of the management of CKD-associated osteoporosis and fracture prevention in stage 4-5 CKD patients.
探讨慢性肾脏病（CKD）患者骨质疏松症诊断与管理的当前证据。
骨质疏松症和骨折在老年CKD患者中普遍存在，且与不良的过程指标和结局相关。虽然在未患CKD或CKD 3期以下的患者中，骨质疏松症的治疗通常相似，但在CKD 4 - 5期，仍缺乏指导骨质疏松症管理诸多领域的证据。迫切需要为患有骨质疏松症的CKD和透析患者建立当地多学科护理路径，涉及肾病学家、骨专科医生和骨折联络服务。所有患者都应考虑优化钙和维生素D代谢以及非药物措施，包括运动和预防跌倒。仅基于肾小球滤过率停用骨药物可能构成“肾主义”（基于肾功能的歧视），这将进一步扩大骨质疏松症已有的巨大治疗差距。另一方面，在CKD 4 - 5期抗骨质疏松药物治疗的几乎每个方面都需要更多证据。基于骨转换的预处理评估（使用生物标志物或骨活检）在抗吸收或促合成骨药物之间进行选择的概念，是一个急需批判性重新评估的教条。本叙述性综述旨在总结我们目前对CKD 4 - 5期患者CKD相关骨质疏松症管理和骨折预防的理解。
