open access publication

Article, 2024

Evaluating Osteoporosis in Chronic Kidney Disease: Both Bone Quantity and Quality Matter

Journal of Clinical Medicine, ISSN 2077-0383, Volume 13, 4, Page 1010, 10.3390/jcm13041010

Contributors

Lloret, María Jesús (Corresponding author) [1] [2] Fusaro, Maria 0000-0001-9478-4851 [3] [4] Jørgensen, Hanne Skou 0000-0002-0881-2615 [5] [6] Haarhaus, Mathias Loberg 0000-0001-8274-6356 [7] [8] [9] Gifre, Laia 0000-0001-5226-003X [10] [11] Alfieri, Carlo Maria 0000-0003-3860-5219 [12] [13] Massó, Elisabet 0009-0008-4871-4447 [10] [11] [14] D'Marco, Luis G 0000-0003-0148-891X [15] Evenepoel, Pieter [16] Bover, Jordi 0000-0003-3577-2273 [10] [11] [14]

Affiliations

  1. [1] Institut de Recerca Sant Pau (IR-Sant-Pau), 08025 Barcelona, Spain
    2. [NORA names: Spain; Europe, EU; OECD];
  2. [2] Puigvert Foundation
    3. [NORA names: Spain; Europe, EU; OECD];
  3. [3] Clinical Physiology Institute
    4. [NORA names: Italy; Europe, EU; OECD];
  4. [4] University of Padua
    5. [NORA names: Italy; Europe, EU; OECD];
  5. [5] Aalborg University Hospital
    6. [NORA names: North Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];

Abstract

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

BMD, CKD, Health Organization, World Health Organization, X-ray absorptiometry, absence, absorptiometry, arrangement, assess bone quality, assessment of fracture risk, avoidance, biopsy, bone, bone biopsy, bone mass, bone quality, bone quantity, bone strength, bone turnover, capacity of bone, chronic kidney disease, chronically, clinical practice, collagen, collagen fiber arrangement, composition, comprehensive assessment, comprehensive assessment of fracture risk, computed tomography, cost, criteria, disease, dual-energy X-ray absorptiometry, elasticity, evaluate osteoporosis, evidence, factors, fiber arrangement, fracture, fracture risk, general population, geometry, gold, gold standard, high-resolution peripheral quantitative computed tomography, impact, impact microindentation, implementation, influence elasticity, invasive nature, kidney disease, literature, load-bearing, low bone mass, mass, matrix, matrix composites, matter, measure BMD, measure bone quality, method, microarchitecture, microcrack propagation, microcracks, microindentation, minerals, nature, needs, organization, osteoporosis, peripheral quantitative computed tomography, population, practice, predicting fracture risk, propagation, quality, quality matters, quality needs, quantitative computed tomography, quantity, repair, repair capacity, risk, standards, strength, technique, tomography, turnover

Funders

  • Government of Catalonia

Data Provider: Digital Science

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