{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:08:11Z","timestamp":1792382891961,"version":"4.4.0"},"reference-count":79,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Osteoporosis and fragility fractures are among the most prevalent and clinically significant complications in patients with chronic kidney disease (CKD), particularly in stages G4\u2013G5 and in those undergoing dialysis (G5D). These skeletal disorders are associated with markedly increased morbidity and mortality, including a 2- to 9-fold higher risk of hip fractures compared to the general population, prolonged hospitalization, functional decline, and excess postoperative mortality. Despite this substantial burden, CKD-associated osteoporosis remains underrecognized and undertreated. Limited inclusion of CKD patients in pivotal osteoporosis trials and the absence of high-evidence guidance in clinical guidelines have contributed to a persistent therapeutic gap. PTH analog agents such as teriparatide and abaloparatide have demonstrated robust efficacy in increasing bone mass and reducing fracture risk in the general population. However, their use in CKD remains limited. PTH analog are poorly prescribed in patients with CKD stage G3 and remain off-label for stages G4\u2013G5D, despite the high prevalence of adynamic bone disease across all stages of CKD. Abaloparatide, a selective PTH1 receptor agonist, exerts potent anabolic effects with a lower incidence of hypercalcemia than teriparatide and may offer a favourable safety profile in carefully selected patients. Preliminary data suggest preservation of bone microarchitecture and potential benefits in low-turnover bone disease, although evidence in CKD is still limited. This narrative review examines current evidence on abaloparatide\u2019s potential role in CKD, emphasizing its mechanism of action, efficacy, safety, and relevance for patients with low bone turnover and high fracture risk.<\/jats:p>","DOI":"10.3390\/jcm15010133","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T14:27:51Z","timestamp":1766586471000},"page":"133","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["PTH Analog Therapy in CKD G4\u2013G5D: Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5226-003X","authenticated-orcid":false,"given":"Laia","family":"Gifre","sequence":"first","affiliation":[{"name":"Rheumatology Department, Hospital Germans Trias i Pujol, Research Institute Germans Trias i Pujol (IGTP), Universitat Aut\u00f2noma de Barcelona, C\/Canyet S\/N, 08196 Badalona, 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":"Department of Medicine, University of Padova, 35122 Padova, Italy"},{"name":"Institute of Clinical Physiology (IFC), National Research Council (CNR), 00185 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J.","family":"Lloret","sequence":"additional","affiliation":[{"name":"Nephrology Department, Fundaci\u00f3 Puigvert, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Aut\u00f2noma de Barcelona, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4871-4447","authenticated-orcid":false,"given":"Elisabet","family":"Mass\u00f3","sequence":"additional","affiliation":[{"name":"REMAR-IGTP Group, RICORS 2040, Nephrology Department, Research Institute Germans Trias i Pujol (IGTP), University Hospital Germans Trias i Pujol, Universitat Aut\u00f2noma de Barcelona, 08196 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1311-451X","authenticated-orcid":false,"given":"Pilar","family":"Peris","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital Cl\u00ednic Barcelona, Fundaci\u00f3 de Recerca Cl\u00ednic Barcelona-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5537-1859","authenticated-orcid":false,"given":"Xavier","family":"Nogu\u00e9s","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital del Mar Research Institute, CIBER de Envejecimiento y Fragilidad Saludable, Universitat Pompeu Fabra, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5329-5189","authenticated-orcid":false,"given":"Rosana","family":"Gelpi","sequence":"additional","affiliation":[{"name":"REMAR-IGTP Group, RICORS 2040, Nephrology Department, Research Institute Germans Trias i Pujol (IGTP), University Hospital Germans Trias i Pujol, Universitat Aut\u00f2noma de Barcelona, 08196 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5172-9350","authenticated-orcid":false,"given":"\u00c1gueda","family":"Prior-Espa\u00f1ol","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital Germans Trias i Pujol, Research Institute Germans Trias i Pujol (IGTP), Universitat Aut\u00f2noma de Barcelona, C\/Canyet S\/N, 08196 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7281-9969","authenticated-orcid":false,"given":"Jordi","family":"Ara","sequence":"additional","affiliation":[{"name":"REMAR-IGTP Group, RICORS 2040, Nephrology Department, Research Institute Germans Trias i Pujol (IGTP), University Hospital Germans Trias i Pujol, Universitat Aut\u00f2noma de Barcelona, 08196 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-6252","authenticated-orcid":false,"given":"Mario","family":"Cozzolino","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6757-1906","authenticated-orcid":false,"given":"Pablo A.","family":"Ure\u00f1a-Torres","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis, AURA Nord Saint-Ouen, 93400 Saint-Ouen, France"},{"name":"Department of Renal Physiology, Necker Hospital, University of Paris Descartes, 75015 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-2273","authenticated-orcid":false,"given":"Jordi","family":"Bover","sequence":"additional","affiliation":[{"name":"REMAR-IGTP Group, RICORS 2040, Nephrology Department, Research Institute Germans Trias i Pujol (IGTP), University Hospital Germans Trias i Pujol, Universitat Aut\u00f2noma de Barcelona, 08196 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1038\/sj.ki.5000414","article-title":"Definition, evaluation and classification of renal osteodistrophy: A position statement from Kidney Disease: Improving Global Outcomes 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