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Review
. 2024 Jul 9;17(8):sfae191.
doi: 10.1093/ckj/sfae191. eCollection 2024 Aug.

Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action

Laia Gifre  1 , Elisabet Massó  2 , Maria Fusaro  3 , Mathias Haarhaus  4   5 , Pablo Ureña  6   7 , Mario Cozzolino  8 , Sandro Mazzaferro  9 , Jordi Calabia  10 , Pilar Peris  11 , Jordi Bover  2
Affiliations
Review

Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action

Laia Gifre et al. Clin Kidney J. .

Abstract

Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life, and high risk of subsequent fractures, especially when recent, multiple, or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1-G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density, diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of bone mineral density in 2017 after the publication of the CKD-Mineral and Bone Disorder Kidney Disease: Improving Global Outcomes guidelines. A proactive attitude towards diagnosis, treatment, and research is proposed to avoid therapeutic nihilism.

Keywords: chronic kidney disease; dialysis; kidney transplant; risk factors; vertebral fracture.

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Conflict of interest statement

L.G. declares receipt of lecture fees from UCB, Amgen, Rubió, Stada, Theramex, Lilly, Abbvie, Astellas, Kyowa Kyrin, and Gebro. M.F. declares financial or non-financial interests from Amgen, Abiogen, and Vifor. P.U. declares receipt of honoraria for advisory boards and speaker meetings from Amgen, Astellas, Astra Zeneca, Baxter, GSK, Theradial, and Vifor Pharma. P.P. declares receipt of lecture fees from UCB, Amgen, Rubió, Lilly, Gebro, and Kyowa Kyrin. J.B. declares receipt of advisory and/or lecture fees from Amgen, Abbvie, Sanofi, CSL-Vifor, Astra Zeneca, Rubió, GSK, and Bayer.

Figures

Figure 1:
Figure 1:
Classification of VFs according to Genant's radiological criteria [5].
Figure 2:
Figure 2:
When and how to diagnose a VF: clinical approach and fracture risk classification. REMS, radiofrequency echographic multi spectrometry.
See this image and copyright information in PMC

References

    1. Kendler DL, Bauer DC, Davison KS et al. Vertebral fractures: clinical importance and management. Am J Med 2016;129:221.e1–10. 10.1016/j.amjmed.2015.09.020 - DOI - PubMed
    1. Lindsay R, Silverman SL, Cooper C et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001;285:320–3. 10.1001/jama.285.3.320 - DOI - PubMed
    1. Gifre L, Prior-Español A. Vertebral fragility fractures: the importance of its identification. Med Clin 2023;161:205–6. - PubMed
    1. Camacho P, Petak S, Binkley N et al. American Association of Clinical Endocrinologist/American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract 2020;26:1–46. 10.4158/GL-2020-0524SUPPL - DOI - PubMed
    1. Genant HK, Wu CY, van Kuijk C et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8:1137–48. 10.1002/jbmr.5650080915 - DOI - PubMed