Adynamic bone disorder in chronic kidney disease: meta-analysis and narrative review of potential biomarkers as diagnosis and therapeutic targets
Abstract
Adynamic bone disorder, common in chronic kidney disease (CKD), results from reduced bone turnover, often due to medications such as calcimimetics or high-dose vitamin D analogs that induce low parathyroid hormone (PTH) levels. Numerous factors contributing to PTH hyporesponsiveness, which also induces low bone turnover, include deficient PTH, uremic toxins like indoxyl sulfate, malnutrition, inflammation, and diabetes. Diagnosis typically involves bone biopsy, although it is inconvenient. Biomarkers like bone-specific alkaline phosphatase (BALP) and intact PTH (iPTH) show promise in distinguishing between low and high bone turnover. Meta-analysis suggests that levels of iPTH below 150 pg/mL or BALP levels below 20 μg/l indicate low bone turnover. Treatments aim to improve bone density without hindering repair, with osteo-anabolic medications being favored for low PTH levels and anti-resorptive agents being cautioned. Romosozumab, while effective, has safety concerns that limit its use. Uremic toxins are reduced by AST-120 treatment, which alleviates PTH hypo-responsiveness and bone toxicity. Adjunctive measures include addressing vitamin D deficiency, and diabetes, and utilizing antioxidant and anti-inflammatory therapies. Overall, BALP and iPTH appear as potential promising biomarkers for diagnosing and monitoring adynamic bone disorder in CKD, effectively guiding therapeutic interventions.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Effectiveness of Bisphosphonates and Denosumab on Risk of Vertebral Fractures in Prostate Cancer Patients Under Androgen Deprivation Therapies: A Real-World Prospective Study
- Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
- Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men
- Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study
- Muscle strength and body composition are clinical indicators of osteoporosis
- Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.