Bone turnover markers in the management of CKD-associated osteoporosis - a European consensus.

alkaline phosphatase; bone; bone density; bone remodeling; chronic; chronic kidney disease-mineral and bone disorder; fractures; osteoporosis; renal insufficiency; tartrate-resistant acid phosphatase

Abstract :

[en] Bone turnover abnormalities are common in chronic kidney disease (CKD) and contribute to bone fragility. Recently, the Kidney-Disease: Improving Global Outcomes (KDIGO) introduced the term CKD-associated osteoporosis to describe bone fragility in CKD and highlighted the role of bone turnover markers (BTM) in clinical evaluation and management of bone fragility. However, current clinical practice guidelines lack specific treatment targets for bone turnover. The aim of this consensus was to present recommendations for the use of BTM in the management of CKD-associated osteoporosis. The consensus was conducted by members of relevant working groups of the European Renal Association (ERA), International Osteoporosis Foundation (IOF), European Foundation for Clinical Chemistry and Laboratory Medicine (EFLM), and European Society of Pediatric Nephrology (ESPN). Bone-specific alkaline phosphatase and tartrate resistant acid phosphatase isoform 5b are not renally cleared and considered reliable diagnostic tools for bone evaluation in CKD-associated osteoporosis. Both have been proposed as reference BTM in CKD by a recent international consortium. Intact N-terminal telopeptide of type I collagen can also be used in CKD. The current consensus describes methodological considerations and the clinical usefulness of BTM in risk prediction, choice of therapeutic strategy, and treatment evaluation in CKD-associated osteoporosis. Specific diagnostic ranges for bone turnover abnormalities are provided. Future research should focus on the integration of these reference BTM with other diagnostic tools, establishment of concrete treatment targets, and development of treatment strategies to reach these targets.

Disciplines :

Laboratory medicine & medical technology

Author, co-author :

Haarhaus, Mathias ; Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden ; Diaverum AB, Malmö, Sweden

Jørgensen, Hanne Skou ; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Bacchetta, Justine ; Reference Center for Rare Diseases of Calcium and Phosphate, INSERM1033 Research Unit, Université Lyon, Lyon, France ; Department of Pediatric Nephrology, Hospices Civils de Lyon, Lyon, France

Ferreira, Anibal ; Nova Medical School, Lisbon, Portugal ; Department of Nephrology, Hospital Curry Cabral, Lisbon, Portugal

Ferrari, Serge ; Geneva University Hospital, Geneva 1211, Switzerland

Fusaro, Maria ; National Research Council, Institute of Clinical Physiology, Pisa, Italy ; Department of Medicine, University of Padua, Padua, Italy

Hansen, Ditte ; Institute of Clinical Medicine, University of Copenhagen, Denmark ; Department of Nephrology, Copenhagen University Hospital - Herlev, Copenhagen, Denmark

Ketteler, Markus ; Department of General Internal Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany

Lafage-Proust, Marie-Hélène ; INSERM U1059 SAINBIOSE Université Jean Monnet, Mines Saint-Etienne, Saint-Etienne, France ; Department of Rheumatology, CHU, Saint-Etienne, France

Lalayiannis, Alexander D ; Department of Pediatric Nephrology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom

More authors (7 more)

Language :

English

Title :

Bone turnover markers in the management of CKD-associated osteoporosis - a European consensus.

Publication date :

In press

Journal title :

Nephrology Dialysis Transplantation

ISSN :

0931-0509

eISSN :

1460-2385

Publisher :

Oxford University Press (OUP), England

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://academic.oup.com/ndt/advance-article-pdf/doi/10.1093/ndt/gfag033/66957992/gfag033.pdf

Available on ORBi :

since 25 September 2026

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