Abstract
Advanced chronic kidney disease (CKD G3b-5) as CKD-MBD (mineral and bone disorder associated with CKD) is connected with low bone mineral density (BMD) and significantly increased fracture risk (2-100x) that has a significant negative impact on quality of life and prognosis of these patients. Bone histomorphonetry represents the gold standard for diagnostics of CKD-MBD bone disorder subtypes, however, due to several reasons it is performed rarely in clinical practice.
Thus, more attention is paid to noninvasive differential diagnostic procedures (DXA, markers of bone turnover). Original 2009 KDIGO (Kidney Disease Improving Global Outcomes) guidelines strongly did not recommend DXA in this population because of the absence of data on prediction of fracture risk and non-specificity of DXA in different CKD-MBD bone disorder subtypes).
Nonetheless, the proof of fracture prediction by DXA and high prevalence of osteoporosis led to revision of KDIGO guidelines and practically routine recommendation of DXA in CKD G3b-5D patients with CKD-MBD and/or risk factors of osteoporosis (if the results changes the therapy). However, there are some specificities of DXA assessment in these patients (more significant impairment of cortical bone, over-assessment of BMD in lumbar spine and some advantages of laterogram).