隨著慢性腎臟疾病(chronic kidney disease, CKD)的惡化,骨折的發生率增加。因CKD導致礦物質與骨骼代謝異常的系統性疾病與骨質疏鬆症的治療不同,需要正確的診斷及區別來預防慢性腎臟病患的骨折風險。第1~3期CKD患者可用標準骨密度來診斷骨質疏鬆症,而在後期CKD骨代謝異常疾病更明顯,無法用骨密度診斷。血清生化標誌和/或定量骨組織形態測量可以區分骨質疏鬆症及腎性骨病變。第4和5期的CKD患者骨質疏鬆症的治療並非基於證據的。本篇文章回顧目前對CKD 1~5期的骨質疏鬆症診斷及治療。
The incidence of bone fractures increases with the progression of chronic kidney disease (CKD). Both traditional osteoporosis and chronic kidney disease-mineral bone disorders (CKD-MBD) may occur in these patients; it is clinically important to distinguish between these disorders to prevent fracture risk of chronic kidney patients. Although standard osteoporosis definition is applicable in stage 1 ~ 3 CKD patients, it is not relevant in late stages of CKD since metabolic bone disorders become more evident in these stages. Serum biochemical markers and/or quantitative bone histomorphometry can distinguish osteoporosis and renal osteodystrophy. Appropriateness of osteoporotic medications in late stages of CKD patients is still not clear recently. This article reviews the current concepts on diagnosis and management of osteoporosis among different stages of CKD.