title: Fractures in chronic kidney disease: pursuing the best screening and management.
abstract: OBJECTIVE
  Osteoporotic fractures are common and cause increased sickness and death. Men and women with chronic kidney disease (CKD) are at particularly high risk of osteoporotic fractures. Currently, however, there are no guidelines concerning noninvasive methods to assess fracture risk in CKD. Further, approved treatments to prevent fractures in otherwise healthy men and women are only recommended for use with caution in those with CKD. This review focuses on the recent data that support the use of noninvasive methods to assess fracture risk in CKD and highlights new therapies that could be used in fracture prevention in CKD.
  
  
  RESULTS
  Data from prospective studies demonstrate that low bone mineral density predicts fracture in CKD patients. Post-hoc analyses demonstrate that agents approved for the treatment of postmenopausal osteoporosis (bisphosphonates, denosumab and teriparatide) when given to those with CKD are well tolerated and potentially efficacious with respect to fracture risk reduction.
  
  
  CONCLUSIONS
  To date, patients, and nephrologists taking care of them, have largely ignored fracture risk assessment and treatment in CKD. This should change given recent data. Further studies are needed, specifically bone histomorphometric studies, which will increase our understanding of CKD-mineral bone disease (MBD) pathophysiology, and randomized clinical trials of therapy in patients with CKD.
authors.affiliation: aNephrology Division, Universidade de São Paulo, São Paulo, Brazil bWomen's College Research Institute, University of Toronto, Toronto, Canada cMedicine Master Degree Program, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
authors.forename: Patrícia T
authors.initials: PT
authors.lastname: Goldenstein
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Jamal
authors.forename: Rosa M A
authors.initials: RM
authors.lastname: Moysés
mesh_terms: D000818:Animals; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents