Bone Quality in Chronic Kidney Disease: Definitions and Diagnostics

Abstract

Purpose of review: In this paper, we review the epidemiology, diagnosis, and pathogenesis of fractures and renal osteodystrophy.

Recent findings: The role of bone quality in the pathogenesis of fracture susceptibility in chronic kidney disease (CKD) is beginning to be elucidated. Bone quality refers to bone material properties, such as cortical and trabecular microarchitecture, mineralization, turnover, microdamage, and collagen content and structure. Recent data has added to our understanding of the effects of CKD on alterations to bone quality, emerging data on the role of abnormal collagen structure on bone strength, the potential of non-invasive methods to inform our knowledge of bone quality, and how we can use these methods to inform strategies that protect against bone loss and fractures. However, more prospective data is required. CKD is associated with abnormal bone quality and strength which results in high fracture incidence.

Keywords: Bone mineral density; Bone quality; Dialysis; Fracture; Kidney; Renal osteodystrophy.

Figure 1

³⁵: HR-pQCT provides detailed images of bone geometry and microarchitecture at the radius (left) and tibia (right). (A) Scout view represents the reference line position (solid line) and the measurement site (dotted line). (B) Images from a healthy, post-menopausal white woman. (C) Images from a pre-dialysis female patient with CKD and without fracture. (D) Images from a pre-dialysis female patient with CKD and with prevalent fracture.

Figure 2

Hip fracture incidence increases with progressive CKD. As patients age in the general population there is an increased incidence of hip fracture. This incidence increases with progression of CKD. Data from Alem et al for dialysis patients and the general population from Olmstead Minnesota, Naylor et al for CKD stages 3–4. Pt-yrs = patient years.