Abstract SE-2-1
Osteoporosis in Renal Failure: To Treat or not to Treat? Manju Chandran Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, DUKENUS Graduate Medical School Chapter of Endocrinology, College of Medicine, Singapore Immediate Past President, Endocrine and Metabolic Society of Singapore (EMSS)
Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Practically speaking, osteoporosis is diagnosed by one of two ways: a low trauma fracture which is unexplained by any other cause of bone fragility or when there is a reduction in bone quantity as measured by BMD by dual energy X-ray absorptiometry (DXA). The diagnosis of osteoporosis in Chronic Kidney Disease (CKD) however is fraught with uncertainties. Patients with CKD could have alternations in bone quality due to increased or decreased bone turnover, impaired mineralization, or a combination of these and/or decreases in BMD. This means that techniques, such as BMD testing, to evaluate fracture risk due to osteoporosis may not be as useful in patients with CKD as they are in the general population. Patients with CKD-MBD may have one of 4 metabolic bone diseaSE- High turnover bone disease (Osteitis Fibrosa Cystica), Low turnover bone disease (Adynamic bone disease), Mixed Osteodystophy, and Osteomalacia. The differentiation between these bone diseases is not simple and straightforward and can conclusively be done only by bone biopsy and histomorphometry. In addition to and independent of alterations in bone quality and quantity, CKD patients are more likely to fracture, because they are at an increased risk for falls from muscle weakness and impaired balance secondary to poor nutrition, inactivity, myopathy, and peripheral neuropathy. The treatment of osteoporosis in CKD is also beset with difficulties. Most anti osteoporosis agents are currently contraindicated in patients with creatinine clearance less than 30 ml/ min/m2. In addition to the potential for worsening of renal function, the very real worry of worsening possible adynamic bone disease and thereby causing fractures with the use of potent anti resorptives exist. This presentation will aim to address the issues surrounding the diagnosis of osteoporosis in CKD as well as will the difficulties surrounding its treatment and will explore some of the currently available treatment options of this difficult disease.
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