Secondary osteoporosis UPDATE. Therapy for bone-mineral disease in CKD-5D patients]

Recently, much of the attention given to bone-mineral disorder as the prognostic factor for mortality has focused on their links to chronic kidney disease (CKD-MBD; chronic kidney disease-mineral bone disease), especially in dialysis patients. Bone disease in dialysis patients showed heterogeneity caused by multiple factors other than postmenopausal osteoporosis. Evaluation of the bone mineral density with DEXA and the bone metabolic markers becomes useless for the assessment of bone fragility in dialysis patients. Prevalence of bone fracture in end-stage renal disease patients is 3-4 times higher than that in general population. The skeletal fracture in ESRD patients is suggested to be related with malnutrition. Guidelines of the therapy for bone-mineral disorder in dialysis patients is centered on the prevention of cardio-vascular disease and the mortality. Physicians should carefully understand these effects in the daily clinical practices.