Skip to main content
SpringerLink
Log in

Medikamentöse Therapie von Knochenstoffwechselstörungen bei CKD-MBD („chronic kidney disease – mineral bone disorder“) unter besonderer Berücksichtigung antiresorptiver Wirkstoffe

Pharmaceutical therapy of bone metabolism disorders in chronic kidney disease mineral bone disorder (CKD-MBD) with special respect to antiresorptive substances

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Veränderungen des Knochen- und Mineralstoffwechsels treten bei nahezu allen Patienten mit fortgeschrittener Nierenfunktionseinschränkung auf und bedingen neben einer Steigerung des Risikos für kardiovaskuläre Komplikationen auch eine Steigerung des Risikos für skelettale Komplikationen, insbesondere für Frakturen. Im Gegensatz zur Osteoporose, bei der die Effektivität antiresorptiver und osteoanaboler Therapiestrategien belegt ist, ist die Evidenz für renale Osteopathieformen begrenzt. Dazu sind aussagefähige doppelblinde, placebokontrollierte Studien erforderlich.

Abstract

Disturbances in bone and mineral turnover are common complications in patients with impaired renal function. Besides an increased risk for cardiovascular events they promote skeletal events, such as bone pain and fractures. Evidence for the antifracture efficacy of antiresorptive and osteoanabolic treatment strategies has only been demonstrated for patients with osteoporosis. The use of osteotropic drugs in patients with impaired renal function requires large randomized placebo-controlled trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Rodriguez M, Nemeth E, Martin D (2005) The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol 288:F253–F264

    Article  CAS  PubMed  Google Scholar 

  2. Andress DL (2005) Vitamin D treatment in chronic kidney disease. Semin Dial 18:315–321

    Article  PubMed  Google Scholar 

  3. Torres A et al (1995) Bone disease in predialysis, hemodialysis, and CAPD patients: evidence of a better bone response to PTH. Kidney Int 47:1434–1442

    Article  CAS  PubMed  Google Scholar 

  4. Mittalhenkle A, Gillen DL, Stehman-Breen CO (2004) Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 44:672–679

    Article  PubMed  Google Scholar 

  5. Moe SM (2006) Vascular calcification and renal osteodystrophy relationship in chronic kidney disease. Eur J Clin Invest 36(Suppl 2):51–62

    Article  CAS  PubMed  Google Scholar 

  6. Eastwood JB, Bordier PJ, Wardener HE de (1973) Some biochemical, histological, radiological and clinical features of renal osteodystrophy. Kidney Int 4:128–140

    Article  CAS  PubMed  Google Scholar 

  7. Chapurlat R (2005) Current pharmacological treatment for fibrous dysplasia and perspectives for the future. Joint Bone Spine 72:196–198

    Article  PubMed  Google Scholar 

  8. Slatopolsky E et al (1966) The control of phosphate excretion in uremia. J Clin Invest 45:672–677

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Llach F, Yudd M (1998) Pathogenic, clinical, and therapeutic aspects of secondary hyperparathyroidism in chronic renal failure. Am J Kidney Dis 32(2 Suppl 2):S3–S12

    Article  CAS  PubMed  Google Scholar 

  10. Black DM et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822

    Article  CAS  PubMed  Google Scholar 

  11. Owen TA et al (1991) Pleiotropic effects of vitamin D on osteoblast gene expression are related to the proliferative and differentiated state of the bone cell phenotype: dependency upon basal levels of gene expression, duration of exposure, and bone matrix competency in normal rat osteoblast cultures. Endocrinology 128:1496–1504

    Article  CAS  PubMed  Google Scholar 

  12. Brown EM et al (1993) Cloning and characterization of an extracellular Ca(2 +)-sensing receptor from bovine parathyroid. Nature 366:575–580

    Article  CAS  PubMed  Google Scholar 

  13. Gutierrez OM et al (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Bushinsky DA, Frick KK (2000) The effects of acid on bone. Curr Opin Nephrol Hypertens 9(4):369–379

    Article  CAS  PubMed  Google Scholar 

  15. Aoki Y et al (2005) Overexpression of the human interleukin 1a gene causes osteopenia in mice. J Rheumatol 32:320–324

    CAS  PubMed  Google Scholar 

  16. Kaneki H et al (2006) Tumor necrosis factor promotes Runx2 degradation through up-regulation of Smurf1 and Smurf2 in osteoblasts. J Biol Chem 281:4326–4333

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Venken K et al (2006) Relative impact of androgen and estrogen receptor activation in the effects of androgens on trabecular and cortical bone in growing male mice: a study in the androgen receptor knockout mouse model. J Bone Miner Res 21:576–585

    Article  CAS  PubMed  Google Scholar 

  18. Malluche HH, Monier-Faugere MC (1992) Risk of adynamic bone disease in dialyzed patients. Kidney Int Suppl 38:S62–S67

    CAS  PubMed  Google Scholar 

  19. Al Badr W, Martin KJ (2009) Role of bone biopsy in renal osteodystrophy. Saudi J Kidney Dis Transpl 20:12–19

    Google Scholar 

  20. Lehmann G, Wolf G (2009) Bone-histomorphometry after treatment with teriparatide (PTH 1-34) in a patient with adynamic renal bone disease subsequent to parathyreodectomy. Nephro Dial Transplant Plus 2:49–51

    CAS  Google Scholar 

  21. Tentori F et al (2006) Mortality risk among hemodialysis patients receiving different vitamin D analogs. Kidney Int 70:1858–1865

    Article  CAS  PubMed  Google Scholar 

  22. Block GA et al (2004) Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350:1516–1525

    Article  CAS  PubMed  Google Scholar 

  23. Bergner R (2013) Bisphosphonate therapy in renal osteodystrophy – a review. J Nephrol 26:450–455

    Article  CAS  PubMed  Google Scholar 

  24. Gnant M (2009) The evolving role of zoledronic acid in early breast cancer. Onco Targets Ther 2:95–104

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Miller PD et al (2005) Safety and efficacy of risedronate in patients with age-related reduced renal function as estimated by the Cockcroft and Gault method: a pooled analysis of nine clinical trials. J Bone Miner Res 20:2105–2115

    Article  CAS  PubMed  Google Scholar 

  26. Neer RM et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441

    Article  CAS  PubMed  Google Scholar 

  27. Schulz W, Famira K, Roth J, Delling G (2007) Therapie der histologisch gesicherten, renalen Osteopenie/Osteoporose („adynamic bone disease“) bei chronischen Langzeit-Hämodialysepatienten mit Parathormon-Fragment 1–34, Teriparatid – eine Pilotstudie. Nieren- u Hochdruckkrankheiten 36:333–342

  28. Cummings SR et al (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765

    Article  CAS  PubMed  Google Scholar 

  29. Block GA et al (2012) A single-dose study of denosumab in patients with various degrees of renal impairment. J Bone Miner Res 27:1471–1479

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Jamal SA et al (2011) Effects of denosumab on fracture and bone mineral density by level of kidney function. J Bone Miner Res 26:1829–1835

    Article  CAS  PubMed  Google Scholar 

  31. Lehmann G, Wolf G (2011) Skelettale Komplikationen bei chronischer Niereninsuffizienz und nach Nierentransplantation. Akt Rheumatol 36:291–296

    Article  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Lehmann und G. Wolf geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik Innere Medizin III, Rheumatologie/Osteologie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    G. Lehmann & G. Wolf

Authors
  1. G. Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Lehmann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lehmann, G., Wolf, G. Medikamentöse Therapie von Knochenstoffwechselstörungen bei CKD-MBD („chronic kidney disease – mineral bone disorder“) unter besonderer Berücksichtigung antiresorptiver Wirkstoffe. Z. Rheumatol. 73, 329–334 (2014). https://doi.org/10.1007/s00393-013-1287-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-013-1287-6

Schlüsselwörter

Keywords

Search

Navigation