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. 2024 Nov;31(4):264-278.
doi: 10.11005/jbm.24.789. Epub 2024 Nov 30.

Clinical Utility of Bone Turnover Markers in Chronic Kidney Disease

Praopilad Srisuwarn  1   2 , Richard Eastell  1 , Syazrah Salam  1   3
Affiliations

Clinical Utility of Bone Turnover Markers in Chronic Kidney Disease

Praopilad Srisuwarn et al. J Bone Metab. 2024 Nov.

Abstract

Chronic kidney disease (CKD) often leads to mineral and bone disorders (CKD-MBDs), which are nearly universal in patients undergoing dialysis. CKD-MBD includes abnormal calcium-phosphate metabolism, vascular and soft tissue calcification, and bone abnormalities (renal osteodystrophy [ROD]). Bone fragility in CKD occurs due to low bone mass and poor bone quality, and patients with CKD have higher fracture and mortality rates. Bone histomorphometry is the gold standard for ROD diagnosis; however, it is labor-intensive and expensive. The Kidney Disease Improving Global Outcomes clinical practice guidelines on CKD-MBD suggest serum parathyroid hormone (PTH) and bone-specific alkaline phosphatase (bone ALP) for predicting bone turnover in ROD. In this review, we focus on the role of PTH and bone turnover markers, intact procollagen type N-terminal propeptide of type I collagen, bone ALP, and tartrate-resistant acid phosphatase 5b in diagnosing ROD, predicting fractures, and guiding treatment in patients with CKD.

Keywords: Alkaline phosphatase; Bone diseases; Chronic kidney disease-mineral and bone disorder; Parathyroid hormone.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Circulating parathyroid hormone (PTH) molecular forms and three generations of PTH assay. iPTH, intact parathyroid hormone.
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