Management of X-linked hypophosphatemia in adults.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of Competing Interest ALL has no conflict of interest to declare. MLB reports personal fees from Amgen, Bruno Farmaceutici, Kyowa Kirin, grants and personal fees from Abiogen, Alexion, Amgen, Bruno Farmaceutici, Eli Lilly, Kyowa Kirin, MSD, NPS, Servier, Shire, SPA, personal fees from Alexion, Bruno Farmaceutici, Kyowa Kirin, Servier, Shire, outside the submitted work. AL has received speaker's fees, travel grants and invitations to congresses by Kyowa Kirin. She was investigator in the UX023-CL201 study sponsored by Ultragenyx. PK has received speaker's fees, travel grants and invitation to congresses by Kyowa Kirin. He was investigator of the UX023 CL303 (reference #76) and UX023 CL304 (reference #77) studies sponsored by Ultragenyx. 6. Nephrol Dial Transplant. 2024 Dec 20;40(1):48-59. doi: 10.1093/ndt/gfae197. Multidisciplinary team approach for CKD-associated osteoporosis. Hansen D(1)(2), Jørgensen HS(3)(4), Andersen TL(5)(6)(7)(8), Ferreira AC(9)(10), Ferreira A(9)(10), de Jongh R(11)(12), Keronen S(13), Kröger H(14)(15), Lafage-Proust MH(16), Martola L(13), Poole KES(17), Tong X(14), Evenepoel P(18)(19), Haarhaus M(20)(21). Author information: (1)Department of Nephrology, Copenhagen University Hospital - Herlev, Copenhagen, Denmark. (2)Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. (3)Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. (4)Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark. (5)Molecular Bone Histology (MBH) lab, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. (6)Department of Pathology, Odense University Hospital, Odense, Denmark. (7)Danish Spatial Imaging Consortium (DanSIC), University of Southern Denmark, Odense, Denmark. (8)MBH lab, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark. (9)Department of Nephrology, ULS São José Lisbon, Portugal. (10)Universidade Nova de Lisboa- NOVA Medical School-Nephology, Lisbon, Portugal. (11)Department of Endocrinology and Metabolism, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. (12)Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands. (13)Abdominal Center, Department of Nephrology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. (14)Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland. (15)Department of Orthopedics, Traumatology, and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. (16)INSERM U1059, CHU, Université de Lyon, Saint-Etienne, Lyon, France. (17)NIHR Cambridge Biomedical Research Centre & Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. (18)Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium. (19)Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium. (20)Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden. (21)Diaverum AB, Malmö, Sweden. Chronic kidney disease-mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected four representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKD G5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels. © The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. DOI: 10.1093/ndt/gfae197 PMCID: PMC11852330