Chronic kidney disease – mineral and bone disorder is a systemic disease of the kidneys, bone, and cardiovascular system.

• It manifests with abnormal serum calcium, phosphorus, parathyroid hormone, and alkaline phosphatase due to abnormal vitamin D metabolites, growth hormone, and fibroblast growth factor 23 (FGF-23) as early as CKD stage 3a

“In patients with CKD G3a-G5D with biochemical abnormalities of CKD-MBD and low BMD and/or fragility fractures, we suggest that treatment choice take into account the magnitude and reversibility of the biochemical abnormalities and the progression of CKD, with consideration of a bone biopsy.”(KDIGO guidelines)

• Mineral and bone disorders have a different pathology and treatment path (compared to primary osteoporosis) with a focus on managing (if present) secondary hyperparathyroidism and hyperphosphatemia that target specific serum values.

Bisphosphonates often cannot be used to due to potential to worsen renal disease.  The other medications need to be closely monitored due to risk of hypercalcemia (denosumab and romosozumab) that is much higher in CKD

Pearl: Patients with osteoporosis in the setting of CKD-BMD should have their care coordinated with a nephrologist.