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Title:           Ten tips on how to assess bone health in patients with chronic kidney disease
Subject:         DOI: 10.1093/ckj/sfae093 Clinical Kidney Journal, 17, 5, 15-04-2024. Abstract: Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest 10 practical ‘tips and tricks’ for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, the gold standard for diagnosing renal bone disease, is invasive and not widely available; although useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multidisciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gaps in the diagnosis, particularly early detection, appropriate “real-time” monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.
Keywords:        bone density, chronic kidney disease 0 mineral and bone disorder, fracture, osteoporosis, renal osteodystrophy
Author:          Jørgensen Hanne Skou, Lloret Maria Jesús, Lalayiannis Alexander D., Shroff Rukshana, Evenepoel Pieter,  , Bacchetta Justine, Bravenboer Nathalie, Ferreira Anibal, Fusaro Maria, Haarhaus Mathias, Lafage-Proust Marie-Helene
Creator:         OUP
Producer:        Acrobat Distiller 10.0.0 (Windows)
CreationDate:    Thu May 30 05:03:48 2024 CEST
ModDate:         Thu May 30 05:04:23 2024 CEST
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     Item: 
      Title: INTRODUCTION
      Destination: section*.2
     Item: 
      Title: Be aware of the fracture burden in patients with CKD
      Destination: section*.4
     Item: 
      Title: Define the risk profile with the aid of a fracture prediction tool
      Destination: section*.6
     Item: 
      Title: Review medications and limit exposure to drugs affecting bone health
      Destination: section*.8
     Item: 
      Title: Assess musculoskeletal function and frailty
      Destination: section*.10
     Item: 
      Title: Provide sufficient dietary calcium and vitamin D
      Destination: section*.12
     Item: 
      Title: Monitor biomarkers of mineral and bone disorders
      Destination: section*.14
     Item: 
      Title: Assess bone mass by dual-energy X-ray absorptiometry
      Destination: section*.16
     Item: 
      Title: Consider novel imaging techniques and analyses of bone strength
      Destination: section*.18
     Item: 
      Title: Consider a bone biopsy for complex cases
      Destination: section*.20
     Item: 
      Title: Seek help: the multidisciplinary team approach
      Destination: section*.22
     Item: 
      Title: RESEARCH RECOMMENDATIONS
      Destination: section*.24
     Item: 
      Title: ACKNOWLEDGEMENTS
      Destination: section*.26
     Item: 
      Title: DATA AVAILABILITY STATEMENT
      Destination: section*.28
     Item: 
      Title: CONFLICT OF INTEREST STATEMENT
      Destination: section*.30
     Item: 
      Title: REFERENCES
      Destination: section*.32
   Info: 
    Title: Ten tips on how to assess bone health in patients with chronic kidney disease
    Author: Jørgensen Hanne Skou, Lloret Maria Jesús, Lalayiannis Alexander D., Shroff Rukshana, Evenepoel Pieter,  , Bacchetta Justine, Bravenboer Nathalie, Ferreira Anibal, Fusaro Maria, Haarhaus Mathias, Lafage-Proust Marie-Helene
    Subject: DOI: 10.1093/ckj/sfae093 Clinical Kidney Journal, 17, 5, 15-04-2024. Abstract: Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest 10 practical ‘tips and tricks’ for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, the gold standard for diagnosing renal bone disease, is invasive and not widely available; although useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multidisciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gaps in the diagnosis, particularly early detection, appropriate “real-time” monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.
    Keywords: bone density, chronic kidney disease 0 mineral and bone disorder, fracture, osteoporosis, renal osteodystrophy
    Creator: OUP
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         <prism:copyright>© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.</prism:copyright>
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         <dc:identifier>doi:10.1093/ckj/sfae093</dc:identifier>
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               <rdf:li xml:lang="x-default">© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.</rdf:li>
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         <dc:contributor>
            <rdf:Seq>
               <rdf:li>Jørgensen Hanne Skou</rdf:li>
               <rdf:li>Lloret Maria Jesús</rdf:li>
               <rdf:li>Lalayiannis Alexander D.</rdf:li>
               <rdf:li>Shroff Rukshana</rdf:li>
               <rdf:li>Evenepoel Pieter</rdf:li>
               <rdf:li> </rdf:li>
               <rdf:li>Bacchetta Justine</rdf:li>
               <rdf:li>Bravenboer Nathalie</rdf:li>
               <rdf:li>Ferreira Anibal</rdf:li>
               <rdf:li>Fusaro Maria</rdf:li>
               <rdf:li>Haarhaus Mathias</rdf:li>
               <rdf:li>Lafage-Proust Marie-Helene</rdf:li>
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         <dc:description>
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               <rdf:li xml:lang="x-default">DOI: 10.1093/ckj/sfae093 Clinical Kidney Journal, 17, 5, 15-04-2024. Abstract: Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest 10 practical &amp;#x2018;tips and tricks&amp;#x2019; for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, the gold standard for diagnosing renal bone disease, is invasive and not widely available; although useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multidisciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gaps in the diagnosis, particularly early detection, appropriate &amp;#x201C;real-time&amp;#x201D; monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.</rdf:li>
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         <dc:subject>
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               <rdf:li>bone density</rdf:li>
               <rdf:li>chronic kidney disease 0 mineral and bone disorder</rdf:li>
               <rdf:li>fracture</rdf:li>
               <rdf:li>osteoporosis</rdf:li>
               <rdf:li>renal osteodystrophy</rdf:li>
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         </dc:subject>
         <dc:title>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">Ten tips on how to assess bone health in patients with chronic kidney disease</rdf:li>
            </rdf:Alt>
         </dc:title>
         <dc:creator>
            <rdf:Seq>
               <rdf:li>Jørgensen Hanne Skou, Lloret Maria Jesús, Lalayiannis Alexander D., Shroff Rukshana, Evenepoel Pieter,  , Bacchetta Justine, Bravenboer Nathalie, Ferreira Anibal, Fusaro Maria, Haarhaus Mathias, Lafage-Proust Marie-Helene</rdf:li>
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