Aug 2026· International Journal of Endocrinology· 0 citations· 19 references
TL;DR
Results indicate that radiofrequency echographic multispectrometry provides BMD and fracture risk assessment comparable to DXA in patients on peritoneal dialysis, while also highlighting the impact of vascular calcifications on the diagnostic accuracy of lumbar spine DXA measurements.
Abstract
Osteoporosis is defined as a systemic skeletal disorder characterized by decreased bone mineral density (BMD) and deterioration of bone microarchitecture, leading to increased fracture risk. Among the causes of secondary osteoporosis, chronic kidney disease (CKD) plays a crucial role, as the kidneys are central regulators of endocrine mineral metabolism, including calcium, phosphate, vitamin D, and parathyroid hormone, as well as Klotho-FGF23 axis. These disturbances contribute to the deterioration of BMD and bone quality. Collectively, these factors highlight the need to recognize and further define CKD-associated osteoporosis as a distinct clinical entity. While not routinely required, bone biopsy continues to play an important role in selected complex cases where diagnostic uncertainty persists. Among the available markers, bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b are not significantly affected by renal clearance and are therefore considered reliable indicators of bone metabolism in CKD. Additionally, intact N-terminal telopeptide of type I collagen may also be applied in this clinical setting. Presents of calcification in CKD require the new approaches for BMD assessment in kidney impairment. Results indicate that radiofrequency echographic multispectrometry provides BMD and fracture risk assessment comparable to DXA in patients on peritoneal dialysis, while also highlighting the impact of vascular calcifications on the diagnostic accuracy of lumbar spine DXA measurements. Patients with CKD typically have impaired bone microarchitecture, as evidenced by lower trabecular bone score. A comprehensive and collaborative approach is essential to improve diagnostic accuracy and to develop more precise and effective therapeutic strategies for this patient population.
A practical clinical framework is proposed that integrates endocrine phenotype, vertebral imaging, trabecular bone score, and biochemical assessment into fracture-risk stratification and therapeutic decision-making, enabling improved identification of high- and very-high-risk patients and facilitating the appropriate use of anabolic and antiresorptive therapies.
I. Cincione, Robert A. Marcantonio, Marcellino Monda et al.· Frontiers in Endocrinology· 0 citations
Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a multifaceted syndrome marked by disturbances in bone and mineral metabolism due to chronic kidney disease (CKD). These disruptions involve imbalances in calcium, phosphate, vitamin D, and parathyroid hormone (PTH) levels, which can result in skeletal deformities, vascular calcification, and heightened cardiovascular risk. This article explores the connection between CKD-MBD and bone metabolism, emphasizing the dynamic processes of bone formation and resorption influenced by both systemic and local factors. It discusses the pathophysiology of CKD-MBD, including changes in vitamin D metabolism and the development of secondary hyperparathyroidism. Additionally, the article outlines clinical manifestations such as fractures and cardiovascular complications, along with advanced diagnostic tools and treatment strategies. Effective management of CKD-MBD—through phosphate control, vitamin D supplementation, and the use of calcimimetics—is essential for enhancing patient outcomes. By examining the interactions between CKD, mineral metabolism, and bone health, this article highlights the need for comprehensive strategies to mitigate the systemic effects of CKD-MBD.
Itidal Alatawi· Journal of Biological Insigh...· 0 citations
Chronic kidney disease–associated osteoporosis (CKD-OP) is a highly prevalent—yet frequently underrecognized—condition in patients with advanced CKD. The assessment of bone turnover, mineralization, and volume remains challenging in clinical practice, often requiring bone histomorphometric analysis. Using data from the Brazilian Registry of Bone Biopsies (REBRABO), we identified clinical characteristics associated with these histomorphometric parameters. These findings may help clinicians better characterize the underlying bone phenotype and support a more individualized approach to the diagnosis and management of CKD-associated osteoporosis. Chronic kidney disease–associated osteoporosis (CKD-OP) is characterized by impaired bone quality, and management of bone fragility in CKD partially relies on evaluating bone turnover (T), mineralization (M), and volume (V), through bone biopsy. However, bone biopsy data from large population-based cohorts are limited, making it challenging to identify clinical parameters that are associated with TMV patterns. This cross-sectional study is based on data from the Brazilian Registry of Bone Biopsy (REBRABO) and includes 374 iliac crest bone biopsies from adult patients with CKD5D (median age 51 y), collected between August/15 and December/21. Each biopsy was classified according to bone turnover (low/normal vs. high), mineralization (normal vs. abnormal), and trabecular volume (normal vs. low). Demographic and laboratory parameters were also analyzed. No significant differences in TMV classification were observed based on ethnicity, sex, or diabetes status. Higher turnover was independently associated with younger age, hemodialysis modality, elevated parathyroid hormone (PTH), and alkaline phosphatase (ALP) levels, in a model adjusted for dialysis vintage, prior parathyroidectomy (PTX), and phosphate. Abnormal mineralization was independently associated with age, prior PTX, and lower serum calcium and phosphate, after adjustment for body mass index (BMI), PTH, and ALP. Low trabecular volume was independently associated with older age and lower BMI, in a model adjusted for PTH and history of fractures, and cannot be reliably inferred from biochemical markers. Notably, most patients with adynamic bone also presented with low trabecular volume. Our findings suggest that younger patients undergoing hemodialysis with elevated PTH and ALP levels may benefit from a more intensive approach to the management of hyperparathyroidism. In contrast, 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.
Eduardo J. Duque, Lauren S. Lowe, C. Carbonara et al.· Archives of Osteoporosis· 0 citations
Osteoporosis is a systemic skeletal disease characterized by progressive bone loss and an increased risk of fracture, and it represents a major public health challenge worldwide. Osteoporosis has multiple pathogenic determinants, including age, endocrine disorders and medication. Current therapeutic approaches primarily aim to promote osteogenesis directly or inhibit osteoclast activity; however, these strategies may limit therapeutic efficacy and increase the risk of adverse effects. The present review provided an integrated perspective on the pathogenesis of osteoporosis from the standpoint of glucose metabolism. Glucose oxidation generates ATP and metabolic intermediates that are key to bone homeostasis. During early differentiation, mesenchymal stem cells rely predominantly on glycolysis during commitment toward pre-osteoblasts, whereas maturation into functional osteoblasts depends more notably on oxidative phosphorylation. The fusion and differentiation of osteoclasts require robust mitochondrial oxidation. Lactate derived from anaerobic metabolism has a dual role in bone metabolism. High-risk populations for osteoporosis include postmenopausal women, patients with type 2 diabetes mellitus and individuals with obesity. Estrogen exerts anti-inflammatory and antioxidant effects through receptor activation. Excessive production of advanced glycation end-products disrupts the bone matrix, whereas hyperlipidemia promotes inflammatory factor-induced bone resorption. These pathological changes disrupt the insulin receptor substrate/PI3K/AKT signaling pathway, compromise glucose transporter-mediated cellular glucose uptake and thus, contribute to relative insulin resistance and insufficiency compared with physiological states. In conclusion, the present review demonstrated that abnormal glucose metabolism is a key pathogenic mechanism in osteoporosis and that targeting insulin signaling may represent a fundamental strategy for correcting glucose metabolic abnormalities across diverse etiologies.
Sheng-Yao Peng, Z. Yao, Junzhe Guo et al.· International Journal of Mol...· 0 citations
Effective care in cases of male osteoporosis requires an integrated risk-based approach that extends beyond BMD to include clinical risk factors, secondary causes, and functional status, and improved recognition and sex-specific management strategies are essential to reduce the fracture burden and improve long-term outcomes in men.
Selin Tekin, Alper Gürlek· Turkish Journal of Medical S...· 0 citations
Osteoporosis is a global health concern with bone frailty and high fracture risk. Existing diagnostic paradigms largely rely on bone scanning and bone mineral density evaluation which are hindered by the delayed prediction of fractures, especially in high-risk groups. This review assesses existing and novel Osteoporosis biomarkers, their mechanisms, clinical efficacy, drawbacks, and discusses the best biomarkers in Osteoporosis risk stratification and management, to convert them into better patient care. An online search was conducted, including PubMed, Web of Science, Embase, and Google Scholar up to June 2026. Passed studies were reviewed critically and organized biomarkers into five different panels: traditional and bone turnover markers, mineral metabolism and endocrine regulators, inflammatory and immune mediators, novel metabolic and multi-omics biomarkers, and combined biomarker panels. The traditional markers are still useful in therapeutic monitoring, although they have a natural biological variability that cannot be used to achieve optimum diagnostic use. Combined and inflammatory mediator panels showed greater discriminative ability, with Net Reclassification Index improvements of 0.15-0.23, appropriately reclassifying 15-23 percent of intermediate-risk patients who were misidentified by traditional screening. The highest performance acquisition was experienced in diabetic cohorts, where density-based measurements often miss. The management of osteoporosis should be changed to precision medicine with multi-dimensional biochemical profiling. The clinical utility and cost-effectiveness of the integrated approach in biomarkers make them a mandatory complement to imaging and a crucial point in holistic patient care for improved prognosis.
Wasan Nori, Mohammed Jaffer Jawad, Munaf Jarallah Yaseen et al.· AL-Kindy College Medical Jou...· 0 citations