CKD-ADYNAMIC BONE DISEASE

SUMMARY

1. Low bone turnover state accompanied by reduced bone formation.
2. The cause is oversuppression of PTH by phosphorous binders and concomitant prescription of vitamin D analogs.
3. Most patients with adynamic bone disease are asymptomatic, but they can have fractures and hypercalcemia.

4. Diagnose by observing an intact PTH level of< I 00 pg/mL in a patient with CKD. ALP not elevated.

5. Treat by reducing amount of vitamin D analog and calcium-based phosphate binders (or use non-calcium based binders).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].