6619a555de17aadc62d1798cc79d5f81 pmc_10889712.pdf 100eb40cec490acdac418e5a81f8e03872d9c069 pmc_10889712.pdf fb8ed7f8b5b4154abe85b059df4cf36d20f2fbf14ef28bffc6c8a224cdab51d5 pmc_10889712.pdf Title: Evaluating Osteoporosis in Chronic Kidney Disease: Both Bone Quantity and Quality Matter Subject: Bone strength is determined not only by bone quantity [bone mineral density (BMD)] but also by bone quality, including matrix composition, collagen fiber arrangement, microarchitecture, geometry, mineralization, and bone turnover, among others. These aspects influence elasticity, the load-bearing and repair capacity of bone, and microcrack propagation and are thus key to fractures and their avoidance. In chronic kidney disease (CKD)-associated osteoporosis, factors traditionally associated with a lower bone mass (advanced age or hypogonadism) often coexist with non-traditional factors specific to CKD (uremic toxins or renal osteodystrophy, among others), which will have an impact on bone quality. The gold standard for measuring BMD is dual-energy X-ray absorptiometry, which is widely accepted in the general population and is also capable of predicting fracture risk in CKD. Nevertheless, a significant number of fractures occur in the absence of densitometric World Health Organization (WHO) criteria for osteoporosis, suggesting that methods that also evaluate bone quality need to be considered in order to achieve a comprehensive assessment of fracture risk. The techniques for measuring bone quality are limited by their high cost or invasive nature, which has prevented their implementation in clinical practice. A bone biopsy, high-resolution peripheral quantitative computed tomography, and impact microindentation are some of the methods established to assess bone quality. Herein, we review the current evidence in the literature with the aim of exploring the factors that affect both bone quality and bone quantity in CKD and describing available techniques to assess them. Keywords: osteoporosis; bone mineral density; DXA; fractures; chronic kidney disease; densitometry; bone quality Author: Maria J. Lloret, Maria Fusaro, Hanne S. Jørgensen, Mathias Haarhaus, Laia Gifre, Carlo M. Alfieri, Elisabet Massó, Luis D’Marco, Pieter Evenepoel and Jordi Bover Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue Feb 13 02:12:00 2024 CET ModDate: Tue Feb 13 02:16:46 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 18 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1058544 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SOZKOC+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 TKTUSC+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 QEPTZP+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 AYYXCC+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 TZLIJD+VnURWPalladioL Type 1 Custom yes yes yes 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 48 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 51 0 AAAAAB+PlayfairDisplay-Regular TrueType MacRoman yes yes no 77 0 AAAAAC+PlayfairDisplay-Bold TrueType MacRoman yes yes no 80 0 AAAAAD+Roboto-Bold TrueType MacRoman yes yes no 83 0 AAAAAF+Calibri TrueType WinAnsi yes yes yes 86 0 LJZOLZ+CMSY10 Type 1 Builtin yes yes yes 113 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 129 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 133 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 137 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 141 0 BCDJEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 148 0 Arial TrueType WinAnsi no no no 156 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 192 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 196 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 200 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 204 0 BCDJEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 211 0 Arial TrueType WinAnsi no no no 219 0 BCDLEE+Open Sans TrueType WinAnsi yes yes no 222 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 245 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 259 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 263 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 267 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 271 0 BCDJEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 278 0 BCDMEE+Calibri TrueType WinAnsi yes yes no 286 0 CRUZTT+VnURWPalladioL-Italic Type 1 Custom yes yes yes 302 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-04-27 02:35:08 CEST RepresentationInformation: pmc_10889712.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-04-24 02:34:38 CEST Size: 1058544 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 710 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Bone Quantity Destination: section.2 Children: Item: Title: Decreased Bone Mass in CKD Destination: subsection.2.1 Item: Title: DXA for Bone Quantity Measurement Destination: subsection.2.2 Item: Title: Limitations of DXA Destination: subsection.2.3 Item: Title: Indications for DXA Destination: subsection.2.4 Item: Title: Bone Quality Destination: section.3 Children: Item: Title: Impact of CKD on Bone Quality Destination: subsection.3.1 Children: Item: Title: Uremic Toxins Destination: subsubsection.3.1.1 Item: Title: Bone Turnover Destination: subsubsection.3.1.2 Item: Title: Phosphate Balance Destination: subsubsection.3.1.3 Item: Title: Vitamin D Deficiency Destination: subsubsection.3.1.4 Item: Title: Vitamin K Destination: subsubsection.3.1.5 Item: Title: Systemic Diseases, Comorbidities, and Bone Quality Destination: subsubsection.3.1.6 Item: Title: Techniques for Assessing Bone Quality Destination: subsection.3.2 Children: Item: Title: Bone Biopsy Destination: subsubsection.3.2.1 Item: Title: Trabecular Bone Score Destination: subsubsection.3.2.2 Item: Title: High-Resolution Peripheral Quantitative Computed Tomography Destination: subsubsection.3.2.3 Item: Title: Impact Microindentation Destination: subsubsection.3.2.4 Item: Title: Future Directions Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Evaluating Osteoporosis in Chronic Kidney Disease: Both Bone Quantity and Quality Matter Author: Maria J. Lloret, Maria Fusaro, Hanne S. Jørgensen, Mathias Haarhaus, Laia Gifre, Carlo M. Alfieri, Elisabet Massó, Luis D’Marco, Pieter Evenepoel and Jordi Bover Subject: Bone strength is determined not only by bone quantity [bone mineral density (BMD)] but also by bone quality, including matrix composition, collagen fiber arrangement, microarchitecture, geometry, mineralization, and bone turnover, among others. These aspects influence elasticity, the load-bearing and repair capacity of bone, and microcrack propagation and are thus key to fractures and their avoidance. In chronic kidney disease (CKD)-associated osteoporosis, factors traditionally associated with a lower bone mass (advanced age or hypogonadism) often coexist with non-traditional factors specific to CKD (uremic toxins or renal osteodystrophy, among others), which will have an impact on bone quality. The gold standard for measuring BMD is dual-energy X-ray absorptiometry, which is widely accepted in the general population and is also capable of predicting fracture risk in CKD. Nevertheless, a significant number of fractures occur in the absence of densitometric World Health Organization (WHO) criteria for osteoporosis, suggesting that methods that also evaluate bone quality need to be considered in order to achieve a comprehensive assessment of fracture risk. The techniques for measuring bone quality are limited by their high cost or invasive nature, which has prevented their implementation in clinical practice. A bone biopsy, high-resolution peripheral quantitative computed tomography, and impact microindentation are some of the methods established to assess bone quality. Herein, we review the current evidence in the literature with the aim of exploring the factors that affect both bone quality and bone quantity in CKD and describing available techniques to assess them. 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