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Review
. 2024 Nov 17;16(11):e73882.
doi: 10.7759/cureus.73882. eCollection 2024 Nov.

The Management of Osteoporosis in Chronic Kidney Disease: A Review of Diagnostic and Therapeutic Approaches

Fatima Tariq  1 , Mehjabeen Ahmad  2 , Muhammad Subhan  3 , Syed Muhammad Zaid Alvi  4 , Muhammad Umar Tariq  5 , Sami Ullah  6 , Asma Khalid  6 , Ruqiya Bibi  3 , Muaz Shafique Ur Rehman  7 , Ayesha Abbas  8
Affiliations
Review

The Management of Osteoporosis in Chronic Kidney Disease: A Review of Diagnostic and Therapeutic Approaches

Fatima Tariq et al. Cureus. .

Abstract

Chronic kidney disease (CKD) has shown a growing association with osteoporosis, comprising part of the broader CKD-mineral and bone disorder (CKD-MBD). CKD-MBD is marked by alterations in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism, significantly elevating fracture risk. While traditional osteoporosis treatments such as bisphosphonates, denosumab, and teriparatide have been adapted for CKD patients, recent innovations have introduced agents aimed at enhancing bone mass and reducing fracture incidence. This study aims to evaluate the pathophysiology, diagnostic methods, and tailored management strategies for osteoporosis in CKD patients. A detailed review of the literature was conducted, involving an in-depth search of PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Library databases for studies published between 2017 and 2024. Studies were selected based on inclusion criteria focusing on CKD-related osteoporosis, diagnostic criteria, and treatment outcomes. Data extraction and quality assessment were independently performed by multiple reviewers to ensure thoroughness and reduce bias. Findings highlight that conventional treatments, such as bisphosphonates, denosumab, and teriparatide, when tailored to CKD stages, demonstrate variable effectiveness in lowering fracture risk. Additionally, emerging pharmacologic agents hold promise in improving bone density, though evidence on these newer therapies remains limited. Osteoporosis management in CKD patients necessitates a personalized approach guided by the disease's stage and individual profile. This review underscores the potential of emerging therapies and emphasizes the need for further research to refine treatment protocols, aiming to enhance patient outcomes in this complex population.

Keywords: bisphosphonates; bone mass; chronic kidney disease (ckd); ckd-mineral and bone disorder (ckd-mbd); denosumab; fracture risk; odanacatib; osteoporosis; romosozumab; teriparatide.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA Flowsheet of Selected Studies
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Pathogenesis of Chronic Kidney Disease (CKD)
1,25(OH)2D, 1 alpha, 25-dihydroxyvitamin D3; FGF-23, fibroblast growth factor-23
Figure 3
Figure 3. Bone Metabolism Factors in CKD-MBD
CKD-MBD, chronic kidney disease-mineral bone disease; PTH, parathyroid hormone; FGF-23, fibroblast growth factor-23
See this image and copyright information in PMC

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