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Old and New Drugs for the Management of Bone Disorders in CKD

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Abstract

Disturbances in mineral and bone metabolism are common in patients with chronic kidney disease (CKD), especially those undergoing dialysis. Renal osteodystrophy, which describes an alteration of bone morphology, is an important component of this systemic disorder and may explain the elevated risk of fracture which adversely affects morbidity and mortality. The most common form of renal osteodystrophy is high-turnover bone disease (osteitis fibrosa), which is induced by secondary hyperparathyroidism (SHPT). During the past decade, there has been considerable advances in the management of SHPT, with the introduction of the calcimimetic agents, the optimized use of nutritional and active vitamin D, and the accumulated experience with surgical parathyroidectomy. Studies supported that these advances could translate into improvement of renal bone disease and fracture prevention, as well as decreasing the risk of cardiovascular events and mortality. In this review, we summarize the available clinical evidence on the effect of old and new drugs on bone disorders in patients with CKD.

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Author notes

  1. Hirotaka Komaba, Markus Ketteler, and John Cunningham have been contributed equally to this work.

Authors and Affiliations

  1. Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan

    Hirotaka Komaba & Masafumi Fukagawa

  2. The Institute of Medical Sciences, Tokai University, Isehara, Japan

    Hirotaka Komaba

  3. Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany

    Markus Ketteler

  4. The Royal Free Hospital and UCL Medical School, London, UK

    John Cunningham

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  1. Hirotaka Komaba
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  2. Markus Ketteler
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  4. Masafumi Fukagawa
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Correspondence to Masafumi Fukagawa.

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Conflict of Interest

Hirotaka Komaba has received honoraria, consulting fees, and/or grant support from Bayer Yakuhin, Chugai Pharmaceutical, Japan Tobacco, Kyowa Kirin, Novartis, and Ono Pharmaceutical. Markus Ketteler has received honoraria for consulting and lecture fees from Amgen, Bayer, Kyowa Kirin, Medice, Ono Pharmaceutical, Sanofi, and Vifor Pharma. John Cunningham has receive honoraria, consulting fees, and/or grant support from Vifor Pharma, Amgen, Merck, and Opko Pharma. Masafumi Fukagawa has received honoraria, consulting fees, and/or grant support from Bayer Yakuhin, Fresenius Kabi, Kissei Pharmaceutical, Kyowa Kirin, Ono Pharmaceutical, and Torii Pharmaceutical.

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Komaba, H., Ketteler, M., Cunningham, J. et al. Old and New Drugs for the Management of Bone Disorders in CKD. Calcif Tissue Int 108, 486–495 (2021). https://doi.org/10.1007/s00223-020-00788-y

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