CKD-associated osteoporosis in patients with CKD G4-5D: a pragmatic treatment approach.

Ten tips to reduce fracture risk by non-pharmacologic interventions in CKD-associated osteoporosis

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 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 current literature and describe ten tips of 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, take care of neuropathy, and determine fall risk as well as implementing fracture liaison services are all actions of relevance to the patient with CKD-associated osteoporosis. Like 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.

Eldecalcitol in older adults with kidney vulnerability: a narrative review of risk-based use, dose adjustment, and monitoring.

Treatment of osteoporosis in clinical practice: when, whom, how, and for how long.

Osteoporosis is a highly prevalent chronic disease associated with an increased risk of fragility fractures and a substantial clinical and socioeconomic burden. Its management is based on fracture risk stratification, integrating clinical risk factors, bone mineral density, and tools such as FRAX®. Previous fragility fracture is the strongest predictor of future fractures and, in most cases, indicates the need for pharmacological treatment. In patients at high risk, antiresorptive agents remain the cornerstone of therapy, whereas in those at very high risk, an initial anabolic strategy followed by antiresorptive treatment should be considered. Treatment duration and sequencing require periodic reassessment, particularly with bisphosphonates and denosumab, whose discontinuation must be carefully planned to avoid rebound effects. This practical approach allows individualized clinical decision-making and aims to optimize fracture prevention, treatment adherence, and long-term outcomes in patients with osteoporosis in routine clinical practice settings.

Menopause and osteoporosis: Non-pharmacological and pharmacological management.

BACKGROUND Once osteoporosis has been identified, risk stratification is followed by non- pharmacological and, where needed, pharmacological management, which may include menopausal hormone therapy (MHT) where indicated. OBJECTIVE This article will build on general practitioners' skills in stratifying fracture risk, supporting their patients to maintain bone health and preventing osteoporotic fracture by instigating lifestyle changes along with appropriate pharmacotherapy. DISCUSSION Risk stratification entails integrating fracture history, bone density and FRAX risk into The Royal Australian College of General Practitioners' official modified flowchart. Non-pharmacological treatments, such as ensuring adequate calcium intake and vitamin D sufficiency, form the basis of bone health maintenance. MHT should be considered in women aged <65 years with T-scores between -1.8 and -2.5. Pharmacotherapy is integral to fracture prevention in osteoporosis. Those at very high fracture risk may need a referral to a consultant physician for consideration of bone anabolic therapy.

Clinical risk factors associated with bone biopsy findings in CKD-associated osteoporosis: insights from the Brazilian Registry of Bone Biopsy (REBRABO)

It is suggested that younger patients undergoing hemodialysis with elevated PTH and ALP levels may benefit from a more intensive approach to the management of hyperparathyroidism and older and more frail patients with relatively low PTH levels may be more likely to exhibit low bone volume and turnover and could potentially benefit from therapies aimed at stimulating bone formation, such as anabolic agents.

Lp(a) in chronic kidney disease: state of the art and management perspectives.