title: Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBDs): What the Endocrinologist Needs to Know.
abstract: OBJECTIVE
  Chronic kidney disease-mineral and bone disorders (CKD-MBDs) are a spectrum of abnormalities involving skeletal hormones, minerals, and bone turnover and mineralization. This paper focuses on what the endocrinologist should know about the assessment and management of skeletal and metabolic disorders in CKD-MBDs.
  
  
  METHODS
  Relevant literature was reviewed to (1) define disturbances of minerals and hormones in the course of CKD; (2) identify the variable radiographic and histomorphometric changes of CKD-MBDs; (3) review the association among CKD-MBDs, vascular calcification, cardiovascular disease (CVD), and mortality; and (4) clarify issues in CKD-MBDs therapy.
  
  
  RESULTS
  Assessment and treatment of CKD-MBDs is complicated by progressive changes in bone minerals and skeletal regulatory hormones as kidney function declines. CKD-MBDs are associated with fracture risk, and studies demonstrate that bone mineral density can be used to assess bone loss and fracture risk in these patients. Treatment of CKD-MBDs continues to evolve. Use of calcium, phosphate binders, vitamin D, vitamin D-receptor analogs, and drugs for osteoporosis and CKD-MBDs treatment are discussed in the context of safety and efficacy for patients with CKD.
  
  
  CONCLUSIONS
  The association of CKD with bone disease, vascular calcification, CVD, and mortality mandates earlier recognition and treatment of CKD-MBDs. Osteoporosis as a distinct entity can be diagnosed and managed in CKD, although assessment of osteoporosis becomes challenging in late (stage 4 to 5) CKD. Diabetes is common in early (stage 1 to 3) CKD. In addition, 96% of all individuals identified as having CKD have early CKD. The endocrinologist is uniquely positioned to address and treat both diabetes and many of the metabolic and skeletal disorders associated with early CKD-MBDs, including osteoporosis.
authors: Endocrine, Diabetes & Osteoporosis Clinic (EDOC), Sterling, VA.
authors: Farhad
authors: F
authors: Zangeneh
authors: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota.
authors: Bart L
authors: BL
authors: Clarke
authors: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota.
authors: Daniel L
authors: DL
authors: Hurley
authors: Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio.
authors: Nelson B
authors: NB
authors: Watts
authors: Colorado Center for Bone Research, University of Colorado Health Sciences Center.
authors: Paul D
authors: PD
authors: Miller
mesh_terms: D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology; D016723:Bone Remodeling; D002113:Calcification, Physiologic; D002136:Calcium, Dietary / Q000008:administration & dosage; D004704:Endocrinology; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D061205:Vascular Calcification
chemical_list: D002136:Calcium, Dietary; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23