Hepatobiliary rickets.

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Abstract

[Indexed for MEDLINE] 19. Nefrologia (Engl Ed). 2018 Jan-Feb;38(1):27-33. doi: 10.1016/j.nefro.2017.04.002. Epub 2017 Nov 11. Advances in the evaluation of bone health in kidney transplant patients. [Article in English, Spanish] Pérez-Sáez MJ(1), Prieto-Alhambra D(2), Díez-Pérez A(3), Pascual J(4). Author information: (1)Servicio de Nefrología, Hospital del Mar, Barcelona, España; Institut Mar d'Investigacions Mediques, Barcelona, España; REDinREN, Instituto Carlos III, Madrid, España. (2)Institut Mar d'Investigacions Mediques, Barcelona, España; Oxford NIHR Musculoskeletal Biomedical Research Unit. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. University of Oxford, Oxford, Inglaterra, Reino Unido; CIBERFES, Instituto Carlos III, Madrid, España. (3)Institut Mar d'Investigacions Mediques, Barcelona, España; CIBERFES, Instituto Carlos III, Madrid, España; Servicio de Medicina Interna, Hospital del Mar, Universidad Autonóma de Barcelona, España. (4)Servicio de Nefrología, Hospital del Mar, Barcelona, España; Institut Mar d'Investigacions Mediques, Barcelona, España; REDinREN, Instituto Carlos III, Madrid, España. Electronic address: julpascual@gmail.com. Bone disease related to chronic kidney disease and, particularly, to kidney transplant patients is a common cause or morbidity and mortality, especially due to a higher risk of osteoporotic fractures. Despite the fact that this has been known for decades, to date, an appropriate diagnostic strategy has yet to be established. Apart from bone biopsy, which is invasive and scarcely used, no other technique is available to accurately establish the risk of fracture in kidney patients. Techniques applied to the general population, such as bone densitometry, have not been subjected to sufficient external validation and their use is not systematic. This means that the identification of patients at risk of fracture and therefore those who are candidates for preventive strategies is an unmet need. Bone strength, defined as the ability of the bone to resist fracture, is determined by bone mineral density (measured by bone densitometry), trabecular architecture and bone tissue quality. The trabecular bone score estimates bone microarchitecture, and low values have been described as an independent predictor of increased fracture risk. Bone microindentation is a minimally invasive technique that measures resistance of the bone to micro-cracks (microscopic separation of mineralised collagen fibres), and therefore bone tissue biomechanical properties. The superiority over bone densitometry of the correlation between the parameters measured by trabecular bone score and microindentation with the risk of fracture in diverse populations led us to test its feasibility in chronic kidney disease and kidney transplant patients. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved. DOI: 10.1016/j.nefro.2017.04.002