Perspectives on renal bone disease

Despite the widespread use of vitamin D sterols to treat SHPT among patients with CKD, there is paucity of information about long-term clinical outcomes. These include biochemical control of the disease, the need for surgical parathyroidectomy, and effects on bone mass and skeletal fracture rates. Information about clinical outcomes using calcimimetic agents to treat SHPT is also quite limited, but preliminary results suggest that treatment can achieve sustained reductions in plasma PTH levels over 3 years of follow-up. The need for parathyroidectomy may also diminish and skeletal fractures may occur less often. Additional studies are needed to confirm these preliminary findings. Adynamic bone can occur among patients with CKD either as a component of renal bone disease or as a result of other skeletal disorders. The relationship between adynamic bone and the risk of skeletal fracture remains uncertain. Adynamic renal osteodystrophy can, however, aggravate vascular calcification among patients undergoing hemodialysis. © 2006 International Society of Nephrology.