| [ Summary ] |
Falls and bone fragility both contribute to bone fractures also in patients with chronic kidney disease (CKD). Low production of calcitriol in renal failure leads to increased incidence of falls via reduced muscle strength, which can be restored to some extent with active vitamin D therapy. On the other hand, evaluation of bone fragility is much more difficult than in the general population. This is due to the divergent heterogeneity of renal osteodystrophy, which determines bone quality. As renal function deteriorates, measurement of bone mineral density (BMD) with X-rays becomes useless for the assessment of bone fragility not only due to heterogeneity but also because of overestimation of BMD with this technique, due to the presence of vascular calcification. In fact the newly implemented K/DIGO guidelines for CKD-MBD (CKD-mineral and bone disorders) do not recommend BMD measurement. At this time, the importance of parathyroid hormone in determining bone fragility is stressed. A survey on the prevalence of hip fractures by the Japanese Society for Dialysis Therapy recently revealed that advanced age, female gender, longer dialysis duration, diabetes mellitus, and malnutrition (low serum creatinine, albumin, and body mass index) were independently associated with a higher likelihood of having a prior hip fracture. |