Management of osteoporosis in chronic kidney disease

Patients with chronic kidney disease (CKD) face an excessive burden of bone disease and fracture risk compared with the general population due to metabolic derangements related to renal disease as well as traditional fracture risk factors, osteoporosis and advancing age. Fragility fracture incidence increases with progressive renal impairment and age, and fractures in this group are associated with exaggerated morbidity and mortality. Despite this, the diagnosis and management of osteoporosis in CKD is not well understood and patients are frequently undertreated. This review summarises the current understanding of and recommendations for the diagnosis and management of osteoporosis in CKD and provides a pragmatic approach to fracture risk assessment and reduction in this population.