Treating Bone Disease in CKD

Patients with CKD are high risk for bone problems: here is how to treat them

Terje Asphaug;; Creative Commons 2.0 License

Due to their role in regulating the levels of multiple factors (phosphorus, calcium, parathyroid hormone, vitamin D), the kidneys have a profound role in maintaining bone health. Kidney disease patients are higher risk for bone pain and fractures. Recognition of chronic kidney disease (CKD) in a patient should prompt a further look at their bone health as well since preventive therapy could make the difference between good health versus ending up in a hospital with a broken hip from minimal trauma!


Disease of the bones due to kidney disease is now called CKD related Mineral and Bone Disorder (CKD-MBD) and should be aggressively assessed and treated. Most patients, and a lot of non-nephrology physicians do not appreciate the link between kidney and bone disease. However, most kidney doctors will test you for abnormalities in bone and mineral metabolism as part of your CKD care.


The first step is diagnosis. Your nephrologist will look for clues in your blood tests that will indicate that something might be wrong with your bones. The details of this physiology are explained here. For instance, you might have the level of you parathyroid hormone (PTH) tested by your nephrologist once every six months. Another factor that is commonly assessed is your blood phosphorus level which might go up when people have CKD. 

Other parameters like blood calcium or vitamin D levels could provide further clues to the diagnosis.

Once this is confirmed, your nephrologist will formulate a treatment plan to optimize your bone health, and prevent bone disease from worsening. This is extremely important, not just from a bone health perspective, but also to preserve your heart function. We are increasingly beginning to understand that bone and mineral abnormalities in patients with CKD have damaging effects that affect not just bone health, but also the health of your heart and blood vessels.

It is now well known that CKD patients with uncontrolled bone-mineral disease are more likely to have heart attacks, and die earlier.  

As part of your treatment to address your bone health, you might see the following interventions put in place:

  • You might be started on calcium or vitamin D supplementation. This however is not always as "common sense" a thing as it might seem. In fact, if your parathyroid hormone level is low, this same treatment could be harmful.
  • You might also need medications to keep phosphorus levels in the blood within an optimal range.
  • You might be put on a medication called cinacalcet which acts to reduce PTH levels, and thus reduces the amount of calcium loss from bones that typically happens when PTH levels are high
  • Bisphosphonates, a drug category that includes medications like Alendronate (Fosamax) or Risedronate (Actonel) may or may not be helpful depending on the specific kind of CKD-MBD present (which will be diagnosed by your nephrologist). They are thus only appropriate for a specific kind of patient and are not a "default choice" since CKD-MBD is not the same as osteoporosis. In fact, bisphosphonates cannot even be dosed in patients in stage 4 or 5 kidney disease. 


    Bone disease, now called CKD related Mineral and Bone Disorder, or CKD-MBD is a common problem in CKD patients. This is not the same as run-of-the-mill osteoporosis that you might be more familiar with. Once  diagnosis has been confirmed, prophylactic treatment is necessary; otherwise fractures remain a high possibility. Treatment varies based on the specific disease and could vary from something as mundane as vitamin D supplementation, to more specific drugs like cinacalcet. 

    As you might have gauged, all these are complicated medical situations best addressed by your nephrologist, and there are no DIY fixes. However, what you can do on your part are things that are good for your bone health; exercise regularly, and try to do activities that involve weight bearing. If you smoke, consider quitting. 

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