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Osteoporosis, osteodystrophy, and CKD-MBD in renal disease 

Osteoporosis, osteodystrophy, and CKD-MBD in renal disease
Chapter:
Osteoporosis, osteodystrophy, and CKD-MBD in renal disease
Author(s):

Brian Camilleri

and Gavin Clunie

DOI:
10.1093/med/9780198713340.003.0017
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date: 26 November 2020

Chronic kidney disease-mineral and bone disorders (CKD-MBD) describes the broader clinical syndrome encompassing mineral, bone, and calcific cardiovascular abnormalities that develop as a complication of CKD. The term renal osteodystrophy (ROD) should be restricted to the abnormalities of bone associated with CKD.

Abnormalities in bone turnover prevail in ROD, with high turnover due to secondary or tertiary hyperparathyroidism at one end of the spectrum and low turnover, such as adynamic bone disease and osteomalacia, at the other end.

ROD is an important cause of morbidity, decreased quality of life, and increased risk of fractures.

With more advanced stages of chronic kidney disease, management focusses on maintaining optimal levels of phosphorus, calcium, and PTH.

Osteoporosis in CKD stages 1–3 is managed as in the general population. The situation with stages 4 and 5 remains uncertain, owing to lack of fracture end-point studies.

There is an increased risk of fractures after renal transplantation. This is mainly related to glucocorticoid (GC) use.

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