PTH Analog Therapy in CKD G4-G5D : Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease
Gifre, Laia (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Fusaro, Maria (Università di Padova)
Lloret, Maria Jesus (Fundació Puigvert)
Massó, Elisabet (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Peris, Pilar (Hospital Clínic i Provincial de Barcelona)
Nogués Solán, Xavier (Institut Hospital del Mar d'Investigacions Mèdiques)
Gelpi, Rosana (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Prior-Español, Águeda (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Ara del Rey, Jordi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Cozzolino, Mario (University of Milan)
Ureña-Torres, Pablo (Université Paris Descartes)
Bover, Jordi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)

Data:	2025
Resum:	Osteoporosis and fragility fractures are among the most prevalent and clinically significant complications in patients with chronic kidney disease (CKD), particularly in stages G4-G5 and in those undergoing dialysis (G5D). These skeletal disorders are associated with markedly increased morbidity and mortality, including a 2- to 9-fold higher risk of hip fractures compared to the general population, prolonged hospitalization, functional decline, and excess postoperative mortality. Despite this substantial burden, CKD-associated osteoporosis remains underrecognized and undertreated. Limited inclusion of CKD patients in pivotal osteoporosis trials and the absence of high-evidence guidance in clinical guidelines have contributed to a persistent therapeutic gap. PTH analog agents such as teriparatide and abaloparatide have demonstrated robust efficacy in increasing bone mass and reducing fracture risk in the general population. However, their use in CKD remains limited. PTH analog are poorly prescribed in patients with CKD stage G3 and remain off-label for stages G4-G5D, despite the high prevalence of adynamic bone disease across all stages of CKD. Abaloparatide, a selective PTH1 receptor agonist, exerts potent anabolic effects with a lower incidence of hypercalcemia than teriparatide and may offer a favourable safety profile in carefully selected patients. Preliminary data suggest preservation of bone microarchitecture and potential benefits in low-turnover bone disease, although evidence in CKD is still limited. This narrative review examines current evidence on abaloparatide's potential role in CKD, emphasizing its mechanism of action, efficacy, safety, and relevance for patients with low bone turnover and high fracture risk.
Ajuts:	'No funding was received for the planning or writing of this article.'
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Chronic kidney disease ; CKD-MBD ; Adynamic bone disease ; Osteoporosis ; Fragility fractures ; Bone turnover ; Bone-forming therapies ; Abaloparatide
Publicat a:	Journal of clinical medicine, Vol. 15 (December 2025) , art. 133, ISSN 2077-0383

DOI: 10.3390/jcm15010133
PMID: 41517382

17 p, 967.3 KB

El registre apareix a les col·leccions:
Articles > Articles de recerca
Articles > Articles publicats