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Review
. 2021 Dec;32(12):2397-2405.
doi: 10.1007/s00198-021-05975-7. Epub 2021 Jun 15.

Diagnosis and management of osteoporosis in chronic kidney disease stages 4 to 5D: a call for a shift from nihilism to pragmatism

P Evenepoel  1 , J Cunningham  2 , S Ferrari  3 , M Haarhaus  4 , M K Javaid  5 , M-H Lafage-Proust  6 , D Prieto-Alhambra  7 , P U Torres  8   9 , J Cannata-Andia  10 ; European Renal Osteodystrophy (EUROD) workgroup; an initiative of the CKD-MBD working group of the ERA-EDTA; and the committee of Scientific Advisors and National Societies of the IOF
Affiliations
Review

Diagnosis and management of osteoporosis in chronic kidney disease stages 4 to 5D: a call for a shift from nihilism to pragmatism

P Evenepoel et al. Osteoporos Int. 2021 Dec.

Abstract

The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) CKD-MBD working group, in collaboration with the Committee of Scientific Advisors of the International Osteoporosis Foundation, published a position paper for the diagnosis and management of osteoporosis in patients with CKD stages 4-5D (eGFR < 30 ml/min 1.73 m2). The present article reports and summarizes the main recommendations included in this 2021 document. The following areas are reviewed: diagnosis of osteoporosis; risk factors for fragility fractures; fracture risk assessment; intervention thresholds for pharmacological intervention; general and pharmacological management of osteoporosis; monitoring of treatment, and systems of care, all in patients with CKD stages 4-5D. Guidance is provided for clinicians caring for CKD stages 4-5D patients with osteoporosis, allowing for a pragmatic individualized diagnostic and therapeutic approach as an alternative to current variations in care and treatment nihilism.

Keywords: Chronic kidney disease; Osteoporosis.

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References

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