
Contents
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17.1 Introduction 17.1 Introduction
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17.2 Definitions 17.2 Definitions
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17.2.1 Chronic kidney disease (CKD) classification 17.2.1 Chronic kidney disease (CKD) classification
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17.2.2 CKD-MBD 17.2.2 CKD-MBD
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17.2.3 Osteoporosis and CKD 17.2.3 Osteoporosis and CKD
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17.3 Pathophysiology of CKD-MBD 17.3 Pathophysiology of CKD-MBD
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17.3.1 Secondary hyperparathyroidism (SHPT), vascular calcification, and mortality 17.3.1 Secondary hyperparathyroidism (SHPT), vascular calcification, and mortality
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17.3.2 Optimal PTH levels 17.3.2 Optimal PTH levels
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17.4 Assessment of CKD-MBD 17.4 Assessment of CKD-MBD
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17.4.1 Biochemical abnormalities 17.4.1 Biochemical abnormalities
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17.4.2 Radiographs and dual X-ray absorptiometry (DXA) scanning 17.4.2 Radiographs and dual X-ray absorptiometry (DXA) scanning
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17.4.3 Bone biopsy 17.4.3 Bone biopsy
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17.5 Management of CKD-MBD 17.5 Management of CKD-MBD
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17.5.1 25-hydroxyvitamin D (25-OHD) and CKD 3 17.5.1 25-hydroxyvitamin D (25-OHD) and CKD 3
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17.5.2 Secondary hyperparathyroidism 17.5.2 Secondary hyperparathyroidism
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17.5.2.1 Phosphate binders 17.5.2.1 Phosphate binders
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17.5.2.2 Vitamin D and vitamin D analogues 17.5.2.2 Vitamin D and vitamin D analogues
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17.5.2.3 Calcimimetics 17.5.2.3 Calcimimetics
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17.5.3 Osteoporosis 17.5.3 Osteoporosis
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17.5.3.1 Bisphosphonates 17.5.3.1 Bisphosphonates
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17.5.3.2 Denosumab 17.5.3.2 Denosumab
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17.5.3.3 Other osteoporosis therapies 17.5.3.3 Other osteoporosis therapies
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17.6 Post-transplant osteoporosis and fracture risk 17.6 Post-transplant osteoporosis and fracture risk
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17.6.1 Fracture risk 17.6.1 Fracture risk
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17.6.2 Influences of bone disease after transplantation 17.6.2 Influences of bone disease after transplantation
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17.6.3 Assessment 17.6.3 Assessment
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17.6.4 Management 17.6.4 Management
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17.6.4.1 Bisphosphonates 17.6.4.1 Bisphosphonates
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17.6.4.2 Other therapies 17.6.4.2 Other therapies
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17.7 Summary 17.7 Summary
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Key references Key references
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17 Osteoporosis, osteodystrophy, and CKD-MBD in renal disease
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Published:July 2014
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Abstract
Chronic kidney disease-mineral and bone disorders (CKD-MBD) describes the broader clinical syndrome encompassing mineral, bone, and calcific cardiovascular abnormalities that develop as a complication of CKD. The term renal osteodystrophy (ROD) should be restricted to the abnormalities of bone associated with CKD.
Abnormalities in bone turnover prevail in ROD, with high turnover due to secondary or tertiary hyperparathyroidism at one end of the spectrum and low turnover, such as adynamic bone disease and osteomalacia, at the other end.
ROD is an important cause of morbidity, decreased quality of life, and increased risk of fractures.
With more advanced stages of chronic kidney disease, management focusses on maintaining optimal levels of phosphorus, calcium, and PTH.
Osteoporosis in CKD stages 1–3 is managed as in the general population. The situation with stages 4 and 5 remains uncertain, owing to lack of fracture end-point studies.
There is an increased risk of fractures after renal transplantation. This is mainly related to glucocorticoid (GC) use.
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