Osteoporosis and fractures are common in chronic kidney disease (CKD). While the diagnosis and management of osteoporosis is similar in patients with CKD stages 1-3 as in patients without CKD, decisions differ greatly once patients reach stages 4 and 5. Little is known about treatment of osteoporosis and fractures in advanced CKD and ESRD. In a recent In Practice article in AJKD, Miller discusses practical aspects of bone disease in CKD. The following questions based on the article will test your knowledge on this topic:

1. Which of the following may contribute to the increased risk of fractures in CKD?

A. Secondary hyperparathyroidism

B. Abnormalities in 1,25-dihydroxyvitamin D synthesis

C. Decreased sclerostin levels

D. A&B only

E. A, B, and C

2. True or False: WHO criteria for the diagnosis of osteoporosis can be applied to patients with CKD stages 1 through 3, as long as there are no renal related biochemical abnormalities to suggest CKD-MBD.

3. Which of the following modalities can be reliably used to estimate the fracture risk in patients with CKD stages 4 and 5?

A. Dual energy x-ray absorptiometry (DXA)

B. Peripheral quantitative computerized tomography (PQcT)

C. High resolution peripheral quantitative computerized tomography (HrPQcT)

D. Any of the above

E. None of the above

4. Which of the following statements is TRUE regarding the treatment of osteoporosis?

A. Salmon calcitonin used for treatment of osteoporosis has the additional benefit of reducing the risk for gastrointestinal malignancies.

B. Raloxifene is a selective estrogen receptor modulator (SERM) has been shown to reduce the risk of hip fracture.

C. Bisphosphonates are actively secreted by the proximal tubule of the nephron.

D. Denusomab should be avoided in stages 4 and 5 CKD because it is excreted by the kidney.

5. Which of the following is FALSE with respect to bisphosphonates?

A. Bisphosphonates block bone resorption by inhibiting osteoclastic activity and stabilizing the calcium-phosphate surface.

B. All bisphosphonates have kidney-related toxicity if inappropriately dosed in the setting of reduced GFR.

C. Long-term bisphosphonates use (over 5 years) can negatively impact bone health, and are associated with atypical femur fractures.

Post prepared by Drs. Anna Mathew and Azzour Hazzan, both Assistant Professors at Hofstra North Shore LIJ School of Medicine, Nephrology, New York.

To see answers, please click here.

To view the article abstract or full-text (subscription required), please visit AJKD.org.