CKD-Associated Osteoporosis: A Comprehensive Clinical Update

Authors

• Suthiya Anumas, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand AND Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
• Midori Sakashita, Division of Chronic Kidney Disease Pathophysiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
• Waroot Pholsawatchai, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand AND Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani, ThailandFollow

Keywords

Chronic kidney disease (CKD), Osteoporosis, Bone quantity, Bone quality

Abstract

Objective: To provide an updated overview of the pathophysiology, diagnostic strategies, and treatment options for chronic kidney disease (CKD)-associated osteoporosis. Methods: A narrative review of recent literature and guideline recommendations, including KDIGO 2017 and 2025, with emphasis on bone health assessment and pharmacologic interventions in CKD. Results: CKD impairs bone quantity and quality through mechanisms involving uremic toxins, hormonal imbalances, metabolic acidosis, medications, and secondary hyperparathyroidism. While dual-energy X-ray absorptiometry (DXA) remains the standard for assessing bone mineral density, additional insights are provided by bone turnover markers, high-resolution peripheral quantitative computed tomography (HR-pQCT), and bone biopsy. Both antiresorptive and anabolic agents—such as bisphosphonates, denosumab, raloxifene, teriparatide, and romosozumab—demonstrate efficacy, though their uses must be carefully tailored, particularly in advanced CKD. Conclusion: Optimal management of osteoporosis in CKD requires individualized diagnostic and therapeutic strategies based on underlying pathophysiology.

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Recommended Citation

Anumas, Suthiya; Sakashita, Midori; and Pholsawatchai, Waroot. 2026 CKD-Associated Osteoporosis: A Comprehensive Clinical Update. Asian Medical Journal and Alternative Medicine. 26, 1 (Apr. 2026), 35-43.
Available at: https://doi.org/10.70933/2773-9465.1330

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