Risk Factors and Management of Osteoporosis Post-Transplant.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare no conflict of interest. 15. Nephrol Dial Transplant. 2021 Jan 1;36(1):42-59. doi: 10.1093/ndt/gfaa192. European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4-G5D. Evenepoel P(1), Cunningham J(2), Ferrari S(3), Haarhaus M(4)(5), Javaid MK(6), Lafage-Proust MH(7), Prieto-Alhambra D(8), Torres PU(9)(10), Cannata-Andia J(11); European Renal Osteodystrophy (EUROD) workgroup, an initiative of the CKD-MBD working group of the ERA-EDTA, and the committee of Scientific Advisors and National Societies of the IOF. Collaborators: Vervloet M, Mazzaferro S, D'Haese P, Bacchetta J, Ferreira A, Salam S, Spasovski G. Author information: (1)Department of Nephrology, KU Leuven University Hospitals Leuven, Leuven, Belgium. (2)Centre for Nephrology, UCL Medical School, Royal Free Campus, London, UK. (3)Service of Bone Diseases, Geneva University Hospital, Switzerland. (4)Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. (5)Diaverum Sweden, Stockholm, Sweden. (6)NDORMS, University of Oxford, Oxford, UK. (7)INSERM U1059, CHU, Université de Lyon, Saint-Etienne, Lyon, France. (8)CSM-NDORMS, University of Oxford, Oxford, UK. (9)Department of Dialysis, AURA Nord Saint Ouen, Saint Ouen, France. (10)Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France. (11)Bone and Mineral Research Unit (ISPA) (REDinREN), Hospital Universitario Central Asturias, Oviedo University, Spain. Controlling the excessive fracture burden in patients with chronic kidney disease (CKD) Stages G4-G5D remains an impressive challenge. The reasons are 2-fold. First, the pathophysiology of bone fragility in patients with CKD G4-G5D is complex and multifaceted, comprising a mixture of age-related (primary male/postmenopausal), drug-induced and CKD-related bone abnormalities. Second, our current armamentarium of osteoporosis medications has not been developed for, or adequately studied in patients with CKD G4-G5D, partly related to difficulties in diagnosing osteoporosis in this specific setting and fear of complications. Doubts about the optimal diagnostic and therapeutic approach fuel inertia in daily clinical practice. The scope of the present consensus paper is to review and update the assessment and diagnosis of osteoporosis in patients with CKD G4-G5D and to discuss the therapeutic interventions available and the manner in which these can be used to develop management strategies for the prevention of fragility fracture. As such, it aims to stimulate a cohesive approach to the management of osteoporosis in patients with CKD G4-G5D to replace current variations in care and treatment nihilism. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. DOI: 10.1093/ndt/gfaa192