Bone and Mineral Disorders in Chronic Kidney Disease

Disturbances of mineral metabolism and associated hormone systems (parathyroid hormone, fibroblastic growth factor [FGF-23], vitamin D, etc.) are very common in chronic kidney disease. This chapter discusses the key bone disturbances, osteitis fibrosa (a manifestation of hyperparathyroidism), osteomalacia (a manifestation of defective mineralization), adynamic bone disease, and osteopenia or osteoporosis, as well as combinations of these abnormalities termed mixed renal osteodystrophy. It also reviews treatment options, including diet, adjustments of dialysis therapy, and drugs such as phosphate binders, vitamin D derivatives, and calcimimetics. In addition, the chapter discusses other abnormalities with skeletal manifestations such as chronic acidosis and β2-microglobulin amyloidosis.