慢性肾脏病患者继发性骨质疏松症的管理

Management of osteoporosis secondary to chronic kidney disease

慢性肾脏病(CKD)继发骨质疏松症的患者骨折风险明显增加,严重影响患者的生活质量,使死亡率增加。规范管理CKD患者继发性骨质疏松症具有重要意义。肾小球滤过率下降带来的全身矿物质代谢异常是导致CKD患者骨质疏松的重要因素。临床诊断和评估CKD患者的骨质疏松,建议根据KDIGO指南进行生化指标的评估,定期检测骨密度,使用风险预测工具如亚洲人骨质疏松自我筛查工具(OSTA)和WHO骨折风险预测简易工具(FRAX)进行骨质疏松骨折风险预测。骨质疏松重在防范,治疗应个体化,除了基础治疗,必要时可采用药物治疗,如活性维生素D、双膦酸盐、降钙素等,但应严格掌握适应症,考虑其在CKD患者中的安全性问题,避免发生高钙血症、血管钙化等临床严重问题。

The risk of fracture in patients with osteoporosis secondary to chronic kidney disease（CKD） increased significantly,which seriously affected the quality of life and increased mortality.Standardized management of osteoporosis secondary to CKD is very important. Abnormal mineral metabolism caused by declined glomerular filtration rate is an important factor leading to osteoporosis in patients with CKD. For clinical diagnosis and evaluation of osteoporosis secondary to CKD,it is recommended to assess biochemical indicators according to the KDIGO guideline,detect the bone mineral density regularly,and predict osteoporosis fracture risk with the risk prediction tools such as the self-assessment tool for Asians（ OSTA） and the fracture risk assessment tool（FRAX）. For management of osteoporosis,the key is prevention,and treatment should be individualized; and if necessary,besides basic therapy,drug therapy can be employed,including active vitamin D,bisphosphonates,and calcitonin,etc,but the indications should be strictly controlled because the safety of the drugs in CKD patients should be considered to avoid serious clinical problems like hypercalcemia and vascular calcification,and so on.