title: Optimal management of bone mineral disorders in chronic kidney disease and end stage renal disease.
abstract: OBJECTIVE
  The review summarizes recent studies on chronic kidney disease-mineral bone disorders, with a focus on new developments in disease management.
  
  
  RESULTS
  The term chronic kidney disease-mineral bone disorder has come to describe an increasingly complex network of alterations in minerals and skeletal disorders that contribute to the significant cardiovascular morbidity and mortality seen in patients with chronic kidney disease and end stage renal disease. Clinical studies continue to suggest associations with clinical outcomes, yet current clinical trials have failed to support causality. Variability in practice exists as current guidelines for management of mineral bone disorders are often based on weak evidence. Recent studies implicate novel pathways for therapeutic intervention in clinical trials.
  
  
  CONCLUSIONS
  Mineral bone disorders in chronic kidney disease arise from alterations in a number of molecules in an increasingly complex physiological network interconnecting bone and the cardiovascular system. Despite extensive associations with improved outcomes in a number of molecules, clinical trials have yet to prove causality and there is an absence of new therapies available to improve patient outcomes. Additional clinical trials that can incorporate the complexity of mineral bone disorders, and with the ability to intervene on more than one pathway, are needed to advance patient care.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Lundquist
authors.forename: Sagar U
authors.initials: SU
authors.lastname: Nigwekar
mesh_terms: D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology; D002115:Calciphylaxis / Q000209:etiology / Q000628:therapy; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy / Q000209:etiology; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000628:therapy*; D054559:Hyperphosphatemia / Q000209:etiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use
chemical_list: D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23