Multidisciplinary team approach for CKD-associated osteoporosis

Chronic kidney disease mineral and bone disorder (CKD-MBD) contributes substantially to the immense 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 kidney-bone multidisciplinary teams (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative introduced clinical-pathological case-conferences to discuss challenging clinical cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was deemed useful in the diagnostic workup. Out of these cases, we selected four representative patients and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. The four cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKDG5D, 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 renal bone disease. We demonstrate the clinical utility of kidney-bone MDTs for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.