This review, endorsed by the European Renal Osteodystrophy network, explores low bone turnover in chronic kidney disease (CKD), highlighting its inconsistent diagnostic criteria and association with conditions like adynamic bone disease (ABD). ABD, characterized by reduced bone turnover with normal mineralization, is increasingly recognized in hemodialysis patients. Factors such as impaired parathyroid hormone signaling, inflammation, malnutrition, diabetes, and suppressed WNT/β-catenin signaling contribute to low bone turnover, increasing risks for cardiovascular complications and fractures.

Antiresorptive agents like bisphosphonates and denosumab improve bone mineral density in CKD without significant cardiovascular risks but raise concerns about brittle bones, microfractures, and rebound bone loss, especially with denosumab. These risks highlight the need for individualized therapy and careful monitoring. Low bone turnover is not inherently harmful but depends on systemic factors driving its development. The review calls for tailored use of antiresorptive therapies and further studies to refine fracture prevention strategies in CKD.

Reference: Haarhaus M, Evenepoel P; European Renal Osteodystrophy (EUROD) workgroup; Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD) working group of the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA). Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment. Kidney Int. 2021;100(3):546-558. doi: 10.1016/j.kint.2021.04.043.