Evaluating Osteoporosis in Chronic Kidney Disease: Both Bone Quantity and Quality Matter
- PMID: 38398323
- PMCID: PMC10889712
- DOI: 10.3390/jcm13041010
Evaluating Osteoporosis in Chronic Kidney Disease: Both Bone Quantity and Quality Matter
Abstract
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.
Keywords: DXA; bone mineral density; bone quality; chronic kidney disease; densitometry; fractures; osteoporosis.
Conflict of interest statement
M.J.L.L. declares receipt of advisory and/or lecture fees from Abbvie, Sanofi, CSL-Vifor, and Rubió. MF declares receipt of advisory and/or lecture fees from Amgen, Vifor, and Abiogen. H.S.J. declares no conflicts of interest. M.H. is an employee of Diaverum, and advisory fees from Resverlogix are not related to the current manuscript. L.G. declares the receipt of lecture fees from UCB, Amgen, Rubió, Stada, Theramex, Lilly, Abbie, Astellas, Kyowa Kyrin, and Gebro. C.A. declares no conflicts of interest. E.M. declares no conflicts of interest. L.D.M. declares the receipt of lecture fees from Esteve and Astra-Zeneca. P.E. declares the receipt of grants from Vifor FMC and Sanofi and advisory fees from Vifor FMC. J.B. declares receipt of advisory and/or lecture fees from Amgen, Abbvie, Sanofi, CSL-Vifor, Astra-Zeneca, Rubió, and Bayer.
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