{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:08:01Z","timestamp":1792789681939,"version":"4.5.0"},"reference-count":123,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T00:00:00Z","timestamp":1707436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JMC Legacy Research Fund of Germans Trias i Pujol University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Bone strength is determined not only by bone quantity [bone mineral density (BMD)] but also by bone quality, including matrix composition, collagen fiber arrangement, microarchitecture, geometry, mineralization, and bone turnover, among others. These aspects influence elasticity, the load-bearing and repair capacity of bone, and microcrack propagation and are thus key to fractures and their avoidance. In chronic kidney disease (CKD)-associated osteoporosis, factors traditionally associated with a lower bone mass (advanced age or hypogonadism) often coexist with non-traditional factors specific to CKD (uremic toxins or renal osteodystrophy, among others), which will have an impact on bone quality. The gold standard for measuring BMD is dual-energy X-ray absorptiometry, which is widely accepted in the general population and is also capable of predicting fracture risk in CKD. Nevertheless, a significant number of fractures occur in the absence of densitometric World Health Organization (WHO) criteria for osteoporosis, suggesting that methods that also evaluate bone quality need to be considered in order to achieve a comprehensive assessment of fracture risk. The techniques for measuring bone quality are limited by their high cost or invasive nature, which has prevented their implementation in clinical practice. A bone biopsy, high-resolution peripheral quantitative computed tomography, and impact microindentation are some of the methods established to assess bone quality. Herein, we review the current evidence in the literature with the aim of exploring the factors that affect both bone quality and bone quantity in CKD and describing available techniques to assess them.<\/jats:p>","DOI":"10.3390\/jcm13041010","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T08:12:03Z","timestamp":1707466323000},"page":"1010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Evaluating Osteoporosis in Chronic Kidney Disease: Both Bone Quantity and Quality Matter"],"prefix":"10.3390","volume":"13","author":[{"given":"Maria J.","family":"Lloret","sequence":"first","affiliation":[{"name":"Nephrology Department, Fundaci\u00f3 Puigvert, Cartagena 340-350, 08025 Barcelona, Spain"},{"name":"Institut de Recerca Sant Pau (IR-Sant-Pau), 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9478-4851","authenticated-orcid":false,"given":"Maria","family":"Fusaro","sequence":"additional","affiliation":[{"name":"National Research Council (CNR), Institute of Clinical Physiology, 56124 Pisa, Italy"},{"name":"Department of Medicine, University of Padua, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0881-2615","authenticated-orcid":false,"given":"Hanne S.","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark"},{"name":"Department of Nephrology, Aalborg University Hospital, 9000 Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-6356","authenticated-orcid":false,"given":"Mathias","family":"Haarhaus","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden"},{"name":"Diaverum AB, Hyllie Boulevard 53, 215 37 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Gifre","sequence":"additional","affiliation":[{"name":"Rheumatology Department, University Hospital Germans Trias I Pujol, Universitat Aut\u00f2noma de Barcelona, 08193 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo M.","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Unit of Nephrology Dialysis and Renal Transplantation Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet","family":"Mass\u00f3","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, REMAR-IGTP Group, Research Institute Germans Trias I Pujol (IGTP), Universitat Aut\u00f2noma de Barcelona, 08193 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0148-891X","authenticated-orcid":false,"given":"Luis","family":"D\u2019Marco","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Enfermedades Cardiorenales y Metab\u00f3licas, Departamento de Medicina y Cirug\u00eda, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Evenepoel","sequence":"additional","affiliation":[{"name":"Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-2273","authenticated-orcid":false,"given":"Jordi","family":"Bover","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, REMAR-IGTP Group, Research Institute Germans Trias I Pujol (IGTP), Universitat Aut\u00f2noma de Barcelona, 08193 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.2215\/CJN.09500916","article-title":"Fractures in Patients with CKD: Time for Action","volume":"11","author":"Moe","year":"2016","journal-title":"Clin. 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