Journal Article Review Epublish
PubMed: 42824698 DOI: 10.1093/ckj/sfag303
Ten tips to reduce fracture risk by non-pharmacologic interventions in CKD-associated osteoporosis.
Clin Kidney J 19(10):sfag303
Authors: Ditte Hansen, Hanne Skou-Jørgensen, Mehmet Kanbay, Maria Fusaro, Louise Salomo, Susanne Fleig, Stig Molsted, Jesper Ryg, Mathias Haarhaus, Pieter Evenepoel
Affiliations
- Department of Nephrology, Copenhagen University Hospital - Herlev, Copenhagen, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy.
- Department of Medicine, University of Padova, Padova, Italy.
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital - North Zealand, Denmark.
- Geriatric Research and Clinical Evidence (GRACE), Department of Internal Medicine Geriatric Section, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark.
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden.
- Tiohundra AB, Norrtälje, Sweden.
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium.
- Department of Medicine, Division of Nephrology, University Hospitals Leuven, Leuven, Belgium.
Abstract
Chronic kidney disease (CKD)-associated osteoporosis is present in approximately 25% of all patients with CKD. The occurrence increases as kidney function declines, with prevalences up to 75% in elderly dialysis patients. It is often undiagnosed due to the perception that limited treatment options are available for this condition. This inappropriate assumption leads to diagnostic and therapeutic nihilism. The effect-size of pharmacological interventions on bone mineral density in patients with CKD is comparable to or higher than in other forms of osteoporosis. Non-pharmacological interventions can improve bone strength and fracture risk in addition to pharmacological interventions. Importantly, they are often applicable to patients with CKD without restrictions, with some specific considerations in end-stage kidney disease. Due to the increased prevalence of modifiable risk factors for fragility fractures in CKD, non-pharmacological interventions should be provided to all patients with CKD-associated osteoporosis. We review the current literature and describe 10 tips for non-pharmacological interventions with the potential to modify fracture risk in CKD patients: appropriate intake of calcium and vitamin D, adequate nutrition and protein intake, avoidance of smoking and alcohol, medication review, reinforcement of exercise, reducing risk of home hazards, prevention of orthostatic hypotension, taking care of neuropathy and determining fall risk, as well as implementing fracture liaison services, are all actions of relevance to the patient with CKD-associated osteoporosis. As in the general population, non-pharmacological interventions should be the first option to consider when osteoporosis is diagnosed. With this paper, we suggest how this should be tailored to the patient with CKD.
MeSH
Kidney Diseases, Portasystemic Shunt, Transjugular Intrahepatic, Kidney, Osteoporosis, Calcium, Prevalence, Kidney Failure, Chronic, Therapeutics