Experts publish a consensus statement on the treatment of osteoporosis in patients with CKD G4-G5D

Patients with advanced chronic kidney disease (CKD) suffer from decreased bone quality and quantity, with a non-vertebral fracture risk 4 to 6 times higher than the fracture risk of matched controls. Because of the complexity and many challenges involved in diagnosing and treating advanced osteoporosis of chronic kidney disease, there is an exceptionally large care gap, leaving these high-risk patients unprotected against potentially life-threatening vulnerability fractures.

In an effort to advance a paradigm shift in osteoporosis care in CKD, the European Renal Osteodystrophy (EUROD) Working Group, which brings together expertise from the European Renal Association-European Dialysis and Transplant Association and International Osteoporosis Foundation (IOF) Committees of Scientific Advisors and National Societies, the ‘European consensus statement on the diagnosis and treatment of osteoporosis in stages of chronic kidney disease G4-G5D‘.

The consensus provides a brief overview of current clinical practice and outlines practical recommendations for diagnosis, fracture risk assessment, intervention thresholds, non-pharmacological and pharmacological intervention strategies, monitoring and secondary fracture prevention through coordinator-based fracture contact services.

Lead author, Dr. Pieter Evenepoel, Nephrology Department of the University Hospitals Leuven, Leuven, Belgium stated:

“Disturbances in mineral and bone metabolism occur early in the course of CKD and become almost universal in patients with advanced disease. Despite their very high risk of contracting osteoporosis-related fractures, these patients suffer from an enormous lack of osteoporosis care. Clinicians are uncertain about the optimal diagnostic and therapeutic strategy, and this can fuel slowness and a wait-and-see approach to osteoporosis care.

The consensus recommendations are timely and important as chronic kidney disease is a rapidly growing problem worldwide. It is estimated that as many as 10-15% of the adult population is affected. In 2010, an estimated 284 persons per million inhabitants worldwide underwent maintenance dialysis (CKD G5D), and this is still increasing given the rapid increase in chronic cardiometabolic diseases worldwide.

Recent studies suggest similar efficacy of common osteoporosis drugs in patients with CKD G4-G5D as in the general patient population. We hope that the pragmatic consensus recommendations resulting from this successful collaboration between European societies, pertaining to the assessment, treatment and monitoring of bone health in renal disease, will serve to guide a proactive and coherent approach to the treatment of osteoporosis in these high-risk patients. to stimulate. “

Professor Serge Ferrari, co-author and vice chair of the IOF Committee of Scientific Advisers

The recommendations also emphasize the importance of coordinator-based fracture contact services in systematically identifying and guiding patients with chronic kidney disease with fragile fractures, in close collaboration with nephrologists as part of the multidisciplinary team.


International Osteoporosis Foundation

Journal reference:

Evenepoel, P., et al. (2020) European Consensus Statement on the Diagnosis and Treatment of Osteoporosis in Stages of Chronic Kidney Disease G4-G5D. Nephrology Dialysis Transplantation.

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