{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T03:12:18Z","timestamp":1793416338527,"version":"4.5.0"},"reference-count":187,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T00:00:00Z","timestamp":1666396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,28]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>The coexistence of osteoporosis and chronic kidney disease (CKD) is an evolving healthcare challenge in the face of increasingly aging populations. Globally, accelerating fracture incidence causes disability, impaired quality of life and increased mortality. Consequently, several novel diagnostic and therapeutic tools have been introduced for treatment and prevention of fragility fractures. Despite an especially high fracture risk in CKD, these patients are commonly excluded from interventional trials and clinical guidelines. While management of fracture risk in CKD has been discussed in recent opinion-based reviews and consensus papers in the nephrology literature, many patients with CKD stages 3\u20135D and osteoporosis are still underdiagnosed and untreated. The current review addresses this potential treatment nihilism by discussing established and novel approaches to diagnosis and prevention of fracture risk in patients with CKD stages 3\u20135D. Skeletal disorders are common in CKD. A wide variety of underlying pathophysiological processes have been identified, including premature aging, chronic wasting, and disturbances in vitamin D and mineral metabolism, which may impact bone fragility beyond established osteoporosis. We discuss current and emerging concepts of CKD\u2013mineral and bone disorders (CKD-MBD) and integrate management of osteoporosis in CKD with current recommendations for management of CKD-MBD. While many diagnostic and therapeutic approaches to osteoporosis can be applied to patients with CKD, some limitations and caveats need to be considered. Consequently, clinical trials are needed that specifically study fracture prevention strategies in patients with CKD stages 3\u20135D.<\/jats:p>","DOI":"10.1093\/ckj\/sfac230","type":"journal-article","created":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T12:39:52Z","timestamp":1666442392000},"page":"456-472","source":"Crossref","is-referenced-by-count":49,"title":["Management of fracture risk in CKD\u2014traditional and novel approaches"],"prefix":"10.1093","volume":"16","author":[{"given":"Mathias","family":"Haarhaus","sequence":"first","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet , Stockholm , Sweden"},{"name":"Diaverum Sweden , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6537-9056","authenticated-orcid":false,"given":"Louise","family":"Aaltonen","sequence":"additional","affiliation":[{"name":"Turku University Hospital, Kidney Center, Department of Medicine , Turku , Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cejka","sequence":"additional","affiliation":[{"name":"Department of Medicine III \u2013 Nephrology, Hypertension, Transplantation, Rheumatology, Geriatrics, Ordensklinikum Linz - Elisabethinen Hospital , Linz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-6252","authenticated-orcid":false,"given":"Mario","family":"Cozzolino","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Renal Division, University of Milan , ASST Santi Paolo e Carlo, Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate T","family":"de Jong","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine and Endocrinology , Amsterdam , The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism Institute , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"D'Haese","sequence":"additional","affiliation":[{"name":"Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp , Antwerp , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0797-4321","authenticated-orcid":false,"given":"Pieter","family":"Evenepoel","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospitals Leuven , Leuven , Belgium"},{"name":"Department of Microbiology Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven-University of Leuven , Leuven , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-H\u00e9l\u00e8ne","family":"Lafage-Proust","sequence":"additional","affiliation":[{"name":"INSERM U1059, CHU, Universit\u00e9 de Lyon , Saint-Etienne , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3071-1893","authenticated-orcid":false,"given":"Sandro","family":"Mazzaferro","sequence":"additional","affiliation":[{"name":"Nephrology Unit at Policlinico Umberto I Hospital and Department of Translation and Precision Medicine, Sapienza University of Rome , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"McCloskey","sequence":"additional","affiliation":[{"name":"Academic Unit of Bone Metabolism, Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, Department of Oncology & Metabolism, University of Sheffield , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9236-3906","authenticated-orcid":false,"given":"Syazrah","family":"Salam","sequence":"additional","affiliation":[{"name":"Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK and Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0881-2615","authenticated-orcid":false,"given":"Hanne","family":"Skou J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Department of Microbiology Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven-University of Leuven , Leuven , Belgium"},{"name":"Aarhus University Hospital, Department of Kidney Diseases , Aarhus, Denmark"},{"name":"Aarhus University, Department of Clinical Medicine , Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4607-9415","authenticated-orcid":false,"given":"Marc","family":"Vervloet","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Amsterdam University Medical Center, VU University Amsterdam , Amsterdam , The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,22]]},"reference":[{"key":"2023022812312800200_","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.kisu.2017.04.001","article-title":"Clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"7","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work 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