Therapeutic opportunities for CKD-associated osteoporosis in adults with kidney failure imply screening

BACKGROUND: Fracture risk in patients with chronic kidney disease (CKD) is excessively high. A recent European consensus provides guidance on the comprehensive screening for CKD-associated osteoporosis in patients with CKD stages G4-5D. However, data on the yield and therapeutic implications of this approach in patients with kidney failure is lacking. METHODS: All prevalent dialysis patients aged >50 years or postmenopausal with life expectancy >1 year at a single center were invited for comprehensive bone health assessment, including the evaluation of risk factors, calcium intake, mineral metabolism parameters, bone turnover markers, fracture history, bone mineral density and vertebral fractures by dual-energy X-ray absorptiometry (DXA), handgrip strength and self-reported physical activity. RESULTS: Of 203 patients screened, 121 (mean age 75 years, 55% male) were eligible, of whom 71 underwent comprehensive phenotyping including DXA. CKD-associated osteoporosis was identified in 73% of participants, based on a T-score ≤-2.5 at the hip or lumbar spine (65%), history of fragility fracture (41%) and/or finding of a vertebral fracture (13%). Vitamin D insufficiency (