Bone fracture; Bone turnover markers; CKD-MBD; Vascular calcification; Bone Density Conservation Agents; Biomarkers; Denosumab; Vitamin D; Humans; Italy; Bone Density Conservation Agents/therapeutic use; Biomarkers/blood; Denosumab/therapeutic use; Vitamin D/analogs & derivatives; Vitamin D/therapeutic use; Vitamin D/blood; Surveys and Questionnaires; Male; Female; Nephrology; Renal Insufficiency, Chronic/complications; Osteoporosis/drug therapy; Osteoporosis/etiology; Osteoporosis/diagnosis; Osteoporosis/blood; Practice Patterns, Physicians'/statistics & numerical data; Nephrologists/statistics & numerical data; Nephrologists; Osteoporosis; Practice Patterns, Physicians'; Renal Insufficiency, Chronic; Orthopedics and Sports Medicine
Abstract :
[en] [en] UNLABELLED: Chronic kidney disease (CKD)-associated osteoporosis increases fracture risk, yet clinical guidance remains unclear. A survey of 89 Italian nephrologists revealed heterogeneous biomarker availability and varied treatment approaches. Denosumab was the preferred antiresorptive agent, while anabolic drugs were rarely used. Findings highlight progress in CKD-related bone health management despite existing uncertainties. CKD-associated osteoporosis comprises the skeletal effects of a complex mineral and bone disorder causing increased risks of fragility fractures (FF), cardiovascular events, and mortality. Existing clinical guidance about CKD-associated osteoporosis is vague, leading us to hypothesize that a treatment gap exists and that clinical practice is dependent on local availability of diagnostic tools.
PURPOSE AND METHODS: The aim of the current survey was to determine current attitudes and practices among Italian nephrologists regarding the evaluation and management of CKD-associated osteoporosis. An online survey was designed, consisting of 9 thematic groups with a set of 16 closed questions regarding the availability of biomarkers and BTMs at reference laboratories and their use for the diagnosis and treatment of CKD-associated osteoporosis in patients with different stages of CKD, including CKD stages G4-5 and dialysis patients. Results were compared to a previous survey on the use of BTMs from 2022.
RESULTS: Eighty-nine Italian nephrologists participated in the survey, reporting that parathyroid hormone (PTH), alkaline phosphatase, and 25-hydroxy-vitamin D measurements were available in 92-100% of their reference laboratories. Measurements for fibroblast growth factor-23, Klotho, Matrix Gla protein, procollagen type 1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b were available in 64-74% of cases. Regarding PTH cut-off values, 47.2% followed KDOQI and 43.8% followed KDIGO recommendations. Vitamin D was widely used across CKD stages (cholecalciferol 27-37.1%, calcifediol 9-12.4%, calcitriol 47.2-53.9%, and paricalcitol 21.3-30.3). Denosumab was the preferred antiresorptive agent in all CKD stages (22.5%-28.1%), while the use of bisphosphonates was uncommon in advanced CKD. Anabolic drugs were rarely prescribed.
CONCLUSIONS: The availability of bone biomarkers is heterogeneous, and an uncertainty still exists regarding the clinical use of biomarkers in CKD-associated osteoporosis. Nonetheless, our findings indicate that Italian nephrologists are increasingly taking proactive steps to prevent and treat bone fragility in CKD patients.
Disciplines :
Laboratory medicine & medical technology Urology & nephrology Rheumatology Public health, health care sciences & services
Author, co-author :
Fusaro, Maria; Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa, Italy. dante.lucia11@gmail.com ; Department of Medicine, University of Padua, Padua, Italy. dante.lucia11@gmail.com
Cossettini, Althea; School of Specialization in Nephrology, University of Milan, Milan, Italy
Re Sartò, Giulia Vanessa; UOC Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
Mereu, Maria Cristina; Independent Researcher, Cagliari, Italy
Gallieni, Maurizio; School of Specialization in Nephrology, University of Milan, Milan, Italy ; UOC Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy ; Department of Biomedical and Clinical Sciences Luigi Sacco', University of Milan, Milan, Italy
Bellasi, Antonio; Service of Nephrology, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland
Alfieri, Carlo Maria; Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milan, Italy ; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Cejka, Daniel; Department of Medicine III - Nephrology, Hypertension, Transplantation Medicine, Rheumatology, Geriatrics, Ordensklinikum Linz - Elisabethinen Hospital, Linz, Austria
McCloskey, Eugene; Division of Clinical Medicine, School of Medicine & Population Health, Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Harvey, Nicholas C; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, United Kingdom
Nickolas, Thomas L; Division of Bone and Mineral Diseases, Washington University School of Medicine, St. Louis, MO, USA
Brandi, Maria Luisa; Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca Sulle Malattie Dell'Osso (FIRMO), Florence, Italy
Ferrari, Serge; Division of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, University of Geneva, CH-1211, Geneva, Switzerland
Marino, Carmela; Institute of Clinical Physiology (IFC), National Research Council (CNR), Reggio Calabria, Italy
Giannini, Sandro; Department of Medicine, Medical Clinic 1, University of Padua, Padua, Italy
Sella, Stefania; Department of Medicine, Medical Clinic 1, University of Padua, Padua, Italy
Arcidiacono, Gaetano Paride; Department of Medicine, Medical Clinic 1, University of Padua, Padua, Italy
Simioni, Paolo; Department of Medicine, Medical Clinic 1, University of Padua, Padua, Italy
Plebani, Mario; University of Padua and QI.LAB.MED, Spin-off of the University of Padua, Padua, Italy
Zaninotto, Martina; University of Padua and QI.LAB.MED, Spin-off of the University of Padua, Padua, Italy
De Nicola, Luca; Department of Advanced Medical and Surgical Sciences, Nephrology Unit, Università Della Campania Luigi Vanvitelli, Naples, Italy
Marcantoni, Carmelita; Nephrology Unit, University Hospital Gaspare Rodolico San Marco, Catania, Italy
de Borst, Martin H; Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Ravera, Maura; Dialisi E Trapianto, Clinica Nefrologica, Policlinico San Martino, Genoa, Italy
Frediani, Bruno; Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, Siena University Hospital, Siena, Italy
Bover, Jordi; Nephrology Department, University Hospital Germans Trias i Pujol (HGTiP) & REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916, Badalona, Spain
Lafage-Proust, Marie-Helene; INSERM U1059, France and Service de Rhumatologie, SAINBIOSE Université Jean Monnet, CHU Saint-Etienne, Saint-Etienne, France
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique ; Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
Bertoldo, Francesco; Bone Metabolism and Osteoncology Unit, University of Verona, Verona, Italy
Tripepi, Giovanni; Institute of Clinical Physiology (IFC), National Research Council (CNR), Reggio Calabria, Italy
Haarhaus, Mathias; Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden ; Diaverum AB, Malmö, Sweden
An initiative and on behalf of the CKD-MBD working group the European Renal Association and the Committee of Scientific Advisors and National Societies of the IOF
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