Combination of Biomarkers and Novel Diagnostic Tools in the Management of Osteoporosis in Chronic Kidney Disease: An Update

Chronic kidney disease-mineral and bone disorder (CKD-MDB) is a systemic disorder that occurs as a complication of advanced chronic kidney disease. It includes biochemical alterations (calcium, phosphorus, parathyroid hormone, vitamin D), abnormalities in bone turnover and mineralization, and vascular and soft-tissue calcifications. The development of secondary hyperparathyroidism and profound alterations in bone remodeling culminate in renal osteodystrophy, which contributes to adverse cardiovascular outcomes and increased mortality. This narrative review article aims to summarize the role of novel diagnostic techniques in the early identification of reduced bone mass and risk of fractures in patients with chronic kidney disease. The use of bone turnover markers independent of renal clearance (such as bone-specific alkaline phosphatase, procollagen type 1 N-terminal propeptide and tartrate-resistant acid phosphatase 5b) integrated with dual energy X-ray absorptiometry, trabecular bone score and radiofrequency echographic multispectrometry improves the characterization of mineral status, enabling targeted intervention to prevent bone and cardiovascular complications associated with CKD-MBD.