The spectrum of ROD has changed in the last decades. Can you briefly discuss this finding and explain the reasons behind it?
44 Comments
Rania Mahmoud
For more than six decades, The mineral and bone abnormalities linked with CKD were referred to as “renal osteodystrophy”In 2006, a KDIGO consensus coined a new term “CKD-MBD”
This involves not only the biochemical and histological abnormalities known as “renal osteodystrophy,” but also additional common consequences such bone fragility fractures and vascular and valvular calcification. The term “renal osteodystrophy” was limited to histological bone abnormalities associated with CKD, which required a bone biopsy to categorize the abnormalities based on bone turnover, mineralization, and volume factors (TMV)
In stage 5 CKD patients, a high prevalence of secondary hyperparathyroidism with high bone turnover is expected. However, it is no longer the most common bone disease in the CKD-MBD constellation.
The reasons for this include the aging of CKD patients, an increase in the prevalence of diabetes as a cause of CKD, an excess of calcium and vitamin D, and an aluminum load. As a result, the most common pattern of bone lesions has recently shifted from high to low bone turnover.
It is noted that there is more low turonver diseas than high and this is not expected in terms of CKDMBD pathophysiology.
It could be that we are oversupressing PTH by using calcium binders , calcitriol and high ca dialysate bath. it could also be that patient tend to be cormobid and elderly. what is the rapport between frailty and low turnover state and DM and low turnover state can someone help
ROD was the old term used for what is now known as CKD-MBD.
while in the recent past secondary hyperparathyroidism (high bone turnover) was the most prevalent form of the disease, it is now low bone turnover disease is the most prevalent.
this happened because of several factors including
*aging population
*Prevalence of DM
*overuse of active vitamin D in the early stages of CKD
Spectrum of ROD has changed in the last decades from hightolow turn over bone disease secondary to aging osteoprosis, DM as a cause of CKD, unjustified use of calcium and vitamin D supplements.
Can you briefly discuss this finding and explain the reasons behind it:more than six decades CKD-MBD was known as renal osteodystrophy, in 2006 KDIGO consensus coined CKD-MB, which is not included bone histological and biochemical abnormalities.but also other complication and such as vascular calcifications and and bone fragility fractures.changes in regulatory axis of bone and mineral metabolism affects the regulation of bone remodelling during growth and adulthood.
these changes of CKD-MBD starts in early stages of CKD and their maximum expressions happens in stage 4 and 5. consensus coined
During more than six decades, the mineral and bone disorders associated to CKD were known as “renal osteodystrophy”. In 2006, a KDIGO consensus coined a new term, “CKD-MBD” ,which includes not only the biochemical and bone histological abnormalities referred as “renal osteodystrophy”, but also other common compli- cations, such as bone fragility fractures and vascular and valvular calcification. The term “renal osteodystrophy” was restricted to the histological bone abnormalities associated with CKD, requiring a bone biopsy to classify the abnormalities based on parameters of bone turnover, mineralization, and volume (TMV) .
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover
in the past more than 6 decades mineral and bone abnormality or disorder associated to CKD called renal osteodystrophy ROD
BUT in 2006 a KDIGO used the new term CKD-MBD which include
1- lab . biochemical mineral abnormality
2- bone disorders
3- vascular calcification
and ROD restrict to histological bone abnormality associated to CKD
Thanks Dr. Elsayed
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
Renal osteodystrophy was the common term till 2006. After the recognition of the multisystemic effects of calcium overload and calcifications resulting from that, It became evident that this is a multisystemic condition, the bone is only a part of. Calcium scores relevant to vascular calcifications which are usually in the intima of the blood vessels are the main cause of peripheric and coronary artery disease in this group of population and is related to mortality and morbidity observed in this group of patients.
Thanks Dr. Mahmud
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
In the beginning was adherence for change on bone mineral changes only like ca po4 pth koltho fgf23 vit d but after that the effect of these changes affect on cvs and that lead cause of death due to that changes
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
During more than six decades the term “renal osteodystrophy” was restricted to the histological bone abnormalities associated with CKD, requiring a bone biopsy to classify the abnormalities based on parameters of bone:- turnover, mineralization, and volume In KDIGO 2006 a new term, “CKD-MBD” appeared which includes :- biochemical abnormalities in Alpha hydroxelse CA, PO4, PTH, FGF23 bone specific alkaline phophatse, Klotho, histological abnormalities as high turn over, low turn over, mixed, meniralization, volume bone fragility fractures and vascular calcificaation valvular calcification. Alterations of bone and mineral metabolism significantly affect the regulation of bone modeling during growth and bone remodeling during adulthood. As consequence of the inappropriate or excessive use of some therapies, CKD-MBD can be facilitated or aggravated. Such as excessive use of calcium and vitamin D receptor activators (VDRAs),due to low calcium, these 2 factors cause excessive suppression of PTH and the reduction of bone remodeling.
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation. Recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
In the past, the term renal osteodystrophy includes mineral and bone disorders. In 2006 KDIGO recommended using the term CKD-MBD to describe a systemic disorder that incorporates these abnormalities. These abnormalities are associated with high cardiovascular complications.
The term “renal osteodystrophy” is now exclusively used to define alterations in bone morphology associated with CKD based upon bone biopsy, and it is only one component of the bone abnormalities of CKD-MBD. Bone morphology is classified into high-turnover, low-turnover, and mixed-bone disease. The spectrum of bone abnormalities is based on parameters of bone turnover, mineralization and volume (TMV).
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
During the last decades the mineral and bone disorders associated to CKD were known as (renal osteodystrophy)
2006 KDIGO consensus a new term CKD -MBD which includes not only the biochemical and bone histological abnormalities (refered as ROD )
BUT ALSO BONE FRAGILITY FRACTURES ,VASCULAR CALCIFICATION
===============
ROD was restricted to the histological bone abnormalities associated with CKD requiring bone biopsy to classify the abnormalities based on parameters of bone turnover ,mineralisation and volume (TMV)
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
-Renal Osteodystrophy (ROD) was previously dependant on changes in biochemical level as regard calcium , phosphorus , PTH , vit D and FGF-23 and its klotho and bone abnormalities as regard turnover , mineralization and volume (TMV) only in contrast to the new concept of vascular calcification which was added as a third arm together with lab and bone abnormalities as suggested by the new KDIGO definition and this is mostly done due to the high prevelance of CVD in CKD patients and being the leading cause of death among this population but we should notice the difference in vascular calcification in CKD MBD which is mostly medial in nature in contrast to intimal type in classic astherosclerotic disease
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
At beginning we were looking for bone as passive organ affected by changes in biochemical markers , recently we discovered active endocrine role of bone with effect on other organs including bone vascular calcification .
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
At the begining this entity was restricted to the biochemical and bone histological abnormalities, based on the; Bone turnover.Mineralization.Bone volume.
The new term CKD-MBD, which added: Bone fragility/fracture.Vascular and valvular calcification. FGF23/Klotho role.morbidity/mortality
Thanks Dr. Mahmoud
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
The main changes that occur in ckd were involve the calcium, phosphorous, FGF23 /klotho, PTH, calcidol and calcitriol. These lead to the changes in bone and vascular metabolism which lead to decrease in bone mass, increase in fragility risk and vascular and valvular calcification.
More than 6 decades the disease of bone and mineral metabolism were referred to as renal osteodystrophy. In 2006 kdigo consensus put a term of CKD-MBD not only includes the biochemical and the bone histopathology but also complications which include fragility fracture and vascular and valvular calcification.
The renal osteodystrophy was depend on the bone histopathological changes associated with ckd which involves the parameters bone turnover, mineralization and volume TMV
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
For more than 6 decades, the mineral and bone disorders associated with CKD were known as renal osteodystrophy which was restricted to histological bone abnormalities associated with CKD requiring bone biopsy to classify abnormalities of the bone turnover, mineralization, and volume (TMV).
In 2006, a KDIGO consensus coined a new term “CKD-MBD” which includes not only the biochemical and bone histological abnormalities but also other common complications, such as bone fragility fractures and vascular and valvular calcification.
CKD MBD: a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following:
Abnormalities of calcium, phosphorus, PTH, or VD metabolism
Abnormalities in bone turnover, mineralization, volume, linear growth, or strength
Thanks Dr. Mohammed
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
In CKD diseases, the main alterations occur in Ca, phosphate, FGF23, klotho and the bit d hormonal system, including calcitriol and calcidiol, which lead to important changes in bone and vascular metabolism with very negative clinical consequences such as decreased bone mass and increased fragility, increased vascular calcifications. This process for the last six decades known as renal osteodystrophy. In 2006,a KDIGO consensus coined the new term CKD-MBD AND this is because it doesn’t confine to bone and laboratory finding alone but also other common complications.
CKD-MBD started early in CKD but became more florid in the late stages of CKD 4.5, and one of the factors that aggravate and increase the CKD-MBD is the use of excessive Ca and Vitamin D receptors activators, which can start the reduction in bone remodeling early.
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
(CKD) is commonly associated with disorders of mineral and bone metabolism, manifested by one or a combination of the following three components:
Abnormalities of calcium, phosphorus, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and vitamin D metabolism
Abnormalities in bone turnover, mineralization, volume linear growth, or strength
Extra skeletal calcification
(KDIGO) recommended in 2006 the use of the term chronic kidney disease-mineral and bone disorder (CKD-MBD) to describe a systemic disorder that incorporates these abnormalities Each of these abnormalities is associated with high mortality rates, primarily from cardiovascular complications.
Thanks Dr. Ashraf
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
-The spectrum of ROD has changed in the last decades. Can you briefly discuss this finding?
Indeed,the spectrum of ROD has shifted from high to low turn over bone disease.
Despite this changes both spectrum are associated with the same complications:
IN the last decades, mineral and bone disorders associated with CKD were known as renal osteodystrophy.
Renal osteodystrophywas confined to the histological bone abnormalities associated with CKD, requiring a bone biopsy to classify the abnormalities based on parameters of bone turnover, mineraliza- tion, and volume (TMV).
In 2006, a KDIGO consensus coined a new term, “CKD-MBD” which includes not only the biochemical and bone histological abnormalities described as “renal osteodystrophy”, but also other common complications, such as bone fragility fractures and vascular and valvular calcification.
CKD-MBD:systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: (i) abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; (ii) abnormalities in bone turnover, mineralization, volume, linear growth, or strength; or (iii) vascular or other soft tissue calcification
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
ROD was originally described as a skeletal disorder that was a result of imbalances in minerals caused by impaired kidney function.
The diagnosis ROD needed a bone biopsy and 3 criteria: TMV (bone turnover, mineralization, bone volume).
The specific changes in the bones include decreased bone mineral density, abnormal bone turnover, and alterations in bone structure, which can result in osteoporosis, osteomalacia, adynamic bone disease.
However, as our understanding of the disease has evolved( because of aging population and increased incidence of ckd, the external use of vitamin D , calcium and phosphatbinders), it has become clear that ROD is a complex, multi-system disorder that affects not only the skeleton, but also the cardiovascular and immune systems. It involves FGF23, Klotho, PTH and phosphate -calcium hemostasis, vascular and valvular calcification.
CKD-related mineral and bone diseases were called “renal osteodystrophy” for almost 60 years. In 2006, a KDIGO consensus came up with the name “CKD-MBD” to cover biochemical and bone histology abnormalities called “renal osteodystrophy” as well as other common complications like bone fragility fractures and vascular and valvular calcification.
Renal osteodystrophy was limited to histological bone abnormalities caused by CKD. To find the abnormalities, based on bone turnover, mineralization, and volume (TMV), a bone biopsy had to be done.
Changes in the regulatory axis of bone and mineral metabolism impact development and adult bone remodeling. Early CKD-MBD changes peak in stages 4 and 5. CKD patients’ dysregulated bone and mineral metabolism cause vascular and valvular calcification, which accelerates both systems’ aging. CKD-MBD might be exacerbated by improper or excessive therapy usage.
By not raising blood calcium enough, too much calcium and vitamin D receptor activators (VDRAs) can cause too much PTH suppression and bone remodeling.
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
The changes in the ROD spectrum: Before 2006 the bone disorder associated with CKD was termed ROD, which was restricted to the biochemical and bone histological abnormalities, requiring bone biopsy to classify bone abnormalities based on the;
Bone turnover.
Mineralization.
Bone volume.
KDIGO in 2006 consensus a new term CKD-MBD, which includes in addition to the ROD parameters;
Bone fragility.
Bone fracture.
Vascular and valvular calcification.
Increase in FGF23.
Decrease in Klotho.
Reduction in 1-alpha-hydroxylase in the kidney, which results in low levels of calcitriol, (the activator of VDR, which reduces the calcium absorption in the intestine and stimulates PTH release, (calcium hemostasis).
PTH induces bone turnover and resorption and stimulates the production of the 1-alpha-hydroxylase.
These bone metabolic changes are found to occur in the early stages of CKD, as a result of dysregulation of bone and mineral metabolism. As a consequence of inappropriate or excessive supplements, calcium, and vit.D can aggravate CKD-MBD.
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
For more than six decades, The mineral and bone abnormalities linked with CKD were referred to as “renal osteodystrophy”In 2006, a KDIGO consensus coined a new term “CKD-MBD”
This involves not only the biochemical and histological abnormalities known as “renal osteodystrophy,” but also additional common consequences such bone fragility fractures and vascular and valvular calcification. The term “renal osteodystrophy” was limited to histological bone abnormalities associated with CKD, which required a bone biopsy to categorize the abnormalities based on bone turnover, mineralization, and volume factors (TMV)
In stage 5 CKD patients, a high prevalence of secondary hyperparathyroidism with high bone turnover is expected. However, it is no longer the most common bone disease in the CKD-MBD constellation.
The reasons for this include the aging of CKD patients, an increase in the prevalence of diabetes as a cause of CKD, an excess of calcium and vitamin D, and an aluminum load. As a result, the most common pattern of bone lesions has recently shifted from high to low bone turnover.
It is noted that there is more low turonver diseas than high and this is not expected in terms of CKDMBD pathophysiology.
It could be that we are oversupressing PTH by using calcium binders , calcitriol and high ca dialysate bath. it could also be that patient tend to be cormobid and elderly.
what is the rapport between frailty and low turnover state and DM and low turnover state can someone help
ROD was the old term used for what is now known as CKD-MBD.
while in the recent past secondary hyperparathyroidism (high bone turnover) was the most prevalent form of the disease, it is now low bone turnover disease is the most prevalent.
this happened because of several factors including
*aging population
*Prevalence of DM
*overuse of active vitamin D in the early stages of CKD
Spectrum of ROD has changed in the last decades from high to low turn over bone disease secondary to aging osteoprosis, DM as a cause of CKD, unjustified use of calcium and vitamin D supplements.
Can you briefly discuss this finding and explain the reasons behind it:more than six decades CKD-MBD was known as renal osteodystrophy, in 2006 KDIGO consensus coined CKD-MB, which is not included bone histological and biochemical abnormalities.but also other complication and such as vascular calcifications and and bone fragility fractures.changes in regulatory axis of bone and mineral metabolism affects the regulation of bone remodelling during growth and adulthood.
these changes of CKD-MBD starts in early stages of CKD and their maximum expressions happens in stage 4 and 5.
consensus coined
During more than six decades, the mineral and bone disorders associated to CKD were known as “renal osteodystrophy”. In 2006, a KDIGO consensus coined a new term, “CKD-MBD” ,which includes not only the biochemical and bone histological abnormalities referred as “renal osteodystrophy”, but also other common compli- cations, such as bone fragility fractures and vascular and valvular calcification. The term “renal osteodystrophy” was restricted to the histological bone abnormalities associated with CKD, requiring a bone biopsy to classify the abnormalities based on parameters of bone turnover, mineralization, and volume (TMV) .
Thanks Dr. Asmaa
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover
in the past more than 6 decades mineral and bone abnormality or disorder associated to CKD called renal osteodystrophy ROD
BUT in 2006 a KDIGO used the new term CKD-MBD which include
1- lab . biochemical mineral abnormality
2- bone disorders
3- vascular calcification
and ROD restrict to histological bone abnormality associated to CKD
Thanks Dr. Elsayed
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
Renal osteodystrophy was the common term till 2006. After the recognition of the multisystemic effects of calcium overload and calcifications resulting from that, It became evident that this is a multisystemic condition, the bone is only a part of. Calcium scores relevant to vascular calcifications which are usually in the intima of the blood vessels are the main cause of peripheric and coronary artery disease in this group of population and is related to mortality and morbidity observed in this group of patients.
Thanks Dr. Mahmud
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
In the beginning was adherence for change on bone mineral changes only like ca po4 pth koltho fgf23 vit d but after that the effect of these changes affect on cvs and that lead cause of death due to that changes
Thanks Dr. Rabab
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
During more than six decades the term “renal osteodystrophy” was restricted to the histological bone abnormalities associated with CKD, requiring a bone biopsy to classify the abnormalities based on parameters of bone:-
turnover, mineralization, and volume
In KDIGO 2006 a new term, “CKD-MBD” appeared which includes :-
biochemical abnormalities in Alpha hydroxelse CA, PO4, PTH, FGF23 bone specific alkaline phophatse, Klotho,
histological abnormalities as high turn over, low turn over, mixed, meniralization, volume
bone fragility
fractures and
vascular calcificaation
valvular calcification.
Alterations of bone and mineral metabolism significantly affect the regulation of bone modeling during growth and bone remodeling during adulthood.
As consequence of the inappropriate or excessive use of some therapies, CKD-MBD can be facilitated or aggravated. Such as excessive use of calcium and vitamin D receptor activators (VDRAs),due to low calcium, these 2 factors cause excessive suppression of PTH and the reduction of bone remodeling.
Thanks Dr. Rola
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation. Recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
In the past, the term renal osteodystrophy includes mineral and bone disorders. In 2006 KDIGO recommended using the term CKD-MBD to describe a systemic disorder that incorporates these abnormalities. These abnormalities are associated with high cardiovascular complications.
The term “renal osteodystrophy” is now exclusively used to define alterations in bone morphology associated with CKD based upon bone biopsy, and it is only one component of the bone abnormalities of CKD-MBD. Bone morphology is classified into high-turnover, low-turnover, and mixed-bone disease. The spectrum of bone abnormalities is based on parameters of bone turnover, mineralization and volume (TMV).
Thanks Dr. Amna
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
During the last decades the mineral and bone disorders associated to CKD were known as (renal osteodystrophy)
2006 KDIGO consensus a new term CKD -MBD which includes not only the biochemical and bone histological abnormalities (refered as ROD )
BUT ALSO BONE FRAGILITY FRACTURES ,VASCULAR CALCIFICATION
===============
ROD was restricted to the histological bone abnormalities associated with CKD requiring bone biopsy to classify the abnormalities based on parameters of bone turnover ,mineralisation and volume (TMV)
Thanks Dr. Emad
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
-Renal Osteodystrophy (ROD) was previously dependant on changes in biochemical level as regard calcium , phosphorus , PTH , vit D and FGF-23 and its klotho and bone abnormalities as regard turnover , mineralization and volume (TMV) only in contrast to the new concept of vascular calcification which was added as a third arm together with lab and bone abnormalities as suggested by the new KDIGO definition and this is mostly done due to the high prevelance of CVD in CKD patients and being the leading cause of death among this population but we should notice the difference in vascular calcification in CKD MBD which is mostly medial in nature in contrast to intimal type in classic astherosclerotic disease
Thanks Dr. Mark
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
At beginning we were looking for bone as passive organ affected by changes in biochemical markers , recently we discovered active endocrine role of bone with effect on other organs including bone vascular calcification .
Thanks Dr. ahmed
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
At the begining this entity was restricted to the biochemical and bone histological abnormalities, based on the; Bone turnover.Mineralization.Bone volume.
The new term CKD-MBD, which added: Bone fragility/fracture.Vascular and valvular calcification. FGF23/Klotho role.morbidity/mortality
Thanks Dr. Mahmoud
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
The main changes that occur in ckd were involve the calcium, phosphorous, FGF23 /klotho, PTH, calcidol and calcitriol. These lead to the changes in bone and vascular metabolism which lead to decrease in bone mass, increase in fragility risk and vascular and valvular calcification.
More than 6 decades the disease of bone and mineral metabolism were referred to as renal osteodystrophy. In 2006 kdigo consensus put a term of CKD-MBD not only includes the biochemical and the bone histopathology but also complications which include fragility fracture and vascular and valvular calcification.
The renal osteodystrophy was depend on the bone histopathological changes associated with ckd which involves the parameters bone turnover, mineralization and volume TMV
Thanks Dr. Israa
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
For more than 6 decades, the mineral and bone disorders associated with CKD were known as renal osteodystrophy which was restricted to histological bone abnormalities associated with CKD requiring bone biopsy to classify abnormalities of the bone turnover, mineralization, and volume (TMV).
In 2006, a KDIGO consensus coined a new term “CKD-MBD” which includes not only the biochemical and bone histological abnormalities but also other common complications, such as bone fragility fractures and vascular and valvular calcification.
CKD MBD: a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following:
Thanks Dr. Mohammed
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
In CKD diseases, the main alterations occur in Ca, phosphate, FGF23, klotho and the bit d hormonal system, including calcitriol and calcidiol, which lead to important changes in bone and vascular metabolism with very negative clinical consequences such as decreased bone mass and increased fragility, increased vascular calcifications. This process for the last six decades known as renal osteodystrophy. In 2006,a KDIGO consensus coined the new term CKD-MBD AND this is because it doesn’t confine to bone and laboratory finding alone but also other common complications.
CKD-MBD started early in CKD but became more florid in the late stages of CKD 4.5, and one of the factors that aggravate and increase the CKD-MBD is the use of excessive Ca and Vitamin D receptors activators, which can start the reduction in bone remodeling early.
Thanks Dr. Rihab
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
(CKD) is commonly associated with disorders of mineral and bone metabolism, manifested by one or a combination of the following three components:
(KDIGO) recommended in 2006 the use of the term chronic kidney disease-mineral and bone disorder (CKD-MBD) to describe a systemic disorder that incorporates these abnormalities Each of these abnormalities is associated with high mortality rates, primarily from cardiovascular complications.
Thanks Dr. Ashraf
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
-The spectrum of ROD has changed in the last decades. Can you briefly discuss this finding?
Indeed,the spectrum of ROD has shifted from high to low turn over bone disease.
Despite this changes both spectrum are associated with the same complications:
-Explain the reasons behind it?
Excellent Answer. Thanks Dr. Ben
Thnxs prof
IN the last decades, mineral and bone disorders associated with CKD were known as renal osteodystrophy.
Renal osteodystrophy was confined to the histological bone abnormalities associated with CKD, requiring a bone biopsy to classify the abnormalities based on parameters of bone turnover, mineraliza- tion, and volume (TMV).
In 2006, a KDIGO consensus coined a new term, “CKD-MBD” which includes not only the biochemical and bone histological abnormalities described as “renal osteodystrophy”, but also other common complications, such as bone fragility fractures and vascular and valvular calcification.
CKD-MBD:systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following:
(i) abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism;
(ii) abnormalities in bone turnover, mineralization, volume, linear growth, or strength; or (iii) vascular or other soft tissue calcification
Thanks Dr. Alaa
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
ROD was originally described as a skeletal disorder that was a result of imbalances in minerals caused by impaired kidney function.
The diagnosis ROD needed a bone biopsy and 3 criteria: TMV (bone turnover, mineralization, bone volume).
The specific changes in the bones include decreased bone mineral density, abnormal bone turnover, and alterations in bone structure, which can result in osteoporosis, osteomalacia, adynamic bone disease.
However, as our understanding of the disease has evolved( because of aging population and increased incidence of ckd, the external use of vitamin D , calcium and phosphatbinders), it has become clear that ROD is a complex, multi-system disorder that affects not only the skeleton, but also the cardiovascular and immune systems. It involves FGF23, Klotho, PTH and phosphate -calcium hemostasis, vascular and valvular calcification.
Thanks Dr. Nour
CKD-related mineral and bone diseases were called “renal osteodystrophy” for almost 60 years. In 2006, a KDIGO consensus came up with the name “CKD-MBD” to cover biochemical and bone histology abnormalities called “renal osteodystrophy” as well as other common complications like bone fragility fractures and vascular and valvular calcification.
Renal osteodystrophy was limited to histological bone abnormalities caused by CKD. To find the abnormalities, based on bone turnover, mineralization, and volume (TMV), a bone biopsy had to be done.
Changes in the regulatory axis of bone and mineral metabolism impact development and adult bone remodeling. Early CKD-MBD changes peak in stages 4 and 5. CKD patients’ dysregulated bone and mineral metabolism cause vascular and valvular calcification, which accelerates both systems’ aging. CKD-MBD might be exacerbated by improper or excessive therapy usage.
By not raising blood calcium enough, too much calcium and vitamin D receptor activators (VDRAs) can cause too much PTH suppression and bone remodeling.
Thanks Dr. Weam
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.
The changes in the ROD spectrum:
Before 2006 the bone disorder associated with CKD was termed ROD, which was restricted to the biochemical and bone histological abnormalities, requiring bone biopsy to classify bone abnormalities based on the;
KDIGO in 2006 consensus a new term CKD-MBD, which includes in addition to the ROD parameters;
These bone metabolic changes are found to occur in the early stages of CKD, as a result of dysregulation of bone and mineral metabolism.
As a consequence of inappropriate or excessive supplements, calcium, and vit.D can aggravate CKD-MBD.
Thanks Dr. kamal
Here is a more clarified answer:
A high prevalence of secondary hyperparathyroidism with high bone turnover is expected in in CKD patients’ stage 5. However, nowadays it is not the most frequent bone disease within the CKD-MBD constellation.
The reasons behind that are numerous such as the aging of the CKD patients, the increase in the prevalence of DM as a cause of CKD, the excess of calcium and vitamin D, and the aluminum load. So, recently, the more frequent pattern of bone lesions has changed from high to low bone turnover.