Mineral and Bone Disorder (MBD)
Mineral and Bone Disorder (MBD) in Chronic Kidney Disease (CKD-MBD)
Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism due to CKD, characterized by abnormalities in calcium, phosphorus, parathyroid hormone (PTH), vitamin D metabolism, bone turnover, mineralization, volume, linear growth, or strength, and vascular or other soft tissue calcification12368.
Definition
CKD-MBD is defined as a systemic disorder of mineral and bone metabolism due to CKD manifested by one or a combination of:
- Abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism
- Abnormalities in bone turnover, mineralization, volume, linear growth, or strength
- Vascular or other soft tissue calcification
This broader term replaces the older concept of renal osteodystrophy, which referred mainly to bone pathology, by encompassing both skeletal and extraskeletal manifestations368.
Pathophysiology
- As kidney function declines (starting around CKD stage 3), phosphate excretion decreases, leading to hyperphosphatemia.
- Reduced renal synthesis of active vitamin D (calcitriol) causes hypocalcemia and decreased intestinal calcium absorption.
- Hypocalcemia and hyperphosphatemia stimulate parathyroid hormone (PTH) secretion, leading to secondary hyperparathyroidism.
- Elevated fibroblast growth factor 23 (FGF23) further suppresses calcitriol production and phosphate reabsorption.
- These disturbances cause abnormal bone remodeling and promote vascular and soft tissue calcifications, contributing to cardiovascular disease, a leading cause of death in CKD patients1267.
Clinical Manifestations
- Bone pain, fractures, skeletal deformities
- Muscle weakness
- Pruritus (itching)
- Vascular calcification leading to cardiovascular morbidity and mortality
- Growth retardation in children with CKD
- Increased risk of cardiovascular events due to arterial calcification23567.
Diagnosis
- Laboratory tests: Serum calcium, phosphorus, PTH, alkaline phosphatase, vitamin D levels
- Imaging: Bone X-rays, bone mineral density studies, vascular imaging for calcifications
- Bone biopsy: Gold standard for assessing bone turnover and mineralization abnormalities (renal osteodystrophy component)138.
Management
- Control serum phosphate with dietary restriction and phosphate binders
- Supplement vitamin D or use active vitamin D analogs to suppress PTH
- Use calcimimetics to manage secondary hyperparathyroidism
- Monitor and manage calcium levels carefully to avoid hypercalcemia
- Address cardiovascular risk factors and monitor for vascular calcifications
- Kidney transplantation is the definitive treatment to correct CKD-MBD abnormalities2358.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Systemic disorder of mineral and bone metabolism due to CKD |
| Key Features | Abnormal calcium, phosphorus, PTH, vitamin D metabolism; bone abnormalities; vascular calcification |
| Pathophysiology | Hyperphosphatemia, hypocalcemia, secondary hyperparathyroidism, elevated FGF23 |
| Clinical Signs | Bone pain, fractures, pruritus, vascular calcifications, cardiovascular disease |
| Diagnosis | Lab tests, imaging, bone biopsy |
| Treatment | Phosphate control, vitamin D therapy, calcimimetics, dialysis, transplantation |
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References
- Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) – NCBI
https://www.ncbi.nlm.nih.gov/books/NBK560742/ - Mineral & Bone Disorder in Chronic Kidney Disease – NIDDK
https://www.niddk.nih.gov/health-information/kidney-disease/mineral-bone-disorder - Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) – Dove Press
https://doi.org/10.2147/IJNRD.S203715 - Mineral and Bone Disorder – National Kidney Foundation
https://www.kidney.org/kidney-topics/mineral-and-bone-disorder - Chronic kidney disease mineral and bone disorder – RACGP
https://www1.racgp.org.au/ajgp/2023/january-february/chronic-kidney-disease-mineral-and-bone-disorder - Chronic kidney disease–mineral and bone disorder – Wikipedia
https://en.wikipedia.org/wiki/Chronic_kidney_disease%E2%80%93mineral_and_bone_disorder - Chronic kidney disease–mineral and bone disorder: conclusions – Kidney International
https://doi.org/10.1016/j.kint.2024.02.025 - KDIGO Clinical Practice Guideline Update for CKD-MBD
https://kdigo.org/guidelines/ckd-mbd/
CKD-MBD is a multifaceted disorder linking kidney dysfunction with bone abnormalities and vascular calcifications, requiring comprehensive management to reduce morbidity and mortality in CKD patients.
