Complications and treatment of mineral and bone disorders in chronic kidney disease

Mineral and bone disorders are frequently observed in chronic kidney disease. Prevening these metabolic, bone and cardiovascular consequences requires a treatment strategy based on physiopathology and international recommendations. The precise diagnosis of these mineral and bone disorders is based on serum parathyroid hormone and alkaline phosphatases values allowing to identify secondary hyperparathyroidism and adynamic bone disease, that are both associated with cardiovascular complication together with calcium and phosphate imbalance. Chronic kidney disease-mineral and bone disorders are associated with bone disease and fractures. Bone biopsies are no longer performed and bone mineral density can be used in order to assess the risk for fractures. Vascular calcification is a major cardiovascular risk factor associated with chronic kidney disease-mineral and bone disorders and its prevention needs to normalized both serum calcium and phosphate values, to correct vitamin D deficiendy and to maintain an optimal bone turn over. The main treatments rely on are dietary counseling, dialysis prescription, calcium supplement, phosphate binders, vitamin D derivatives, calcimimetics and surgical parathyroidectomy. We suggest some treatments strategies based on diagnosis criteria in order to help the nephrologist to identify and treat mineral and bone disorders at all chronic kidney disease stages, to decrease complication frequency and to improve the bone and the cardiovascular prognosis of chronic kidney disease patients. (C) 2019 Societe francophone de nephrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.