Use of dual energy X‐ray absorptiometry, the trabecular bone score and quantitative computed tomography in the evaluation of chronic kidney disease‐mineral and bone disorders

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Osteoporosis is defined as a condition characterized by reduced bone strength, leading to an increased risk of minimal trauma fracture (MTF).1 In clinical practice, the diagnosis of osteoporosis is based primarily on bone mineral density (BMD) measured using dual‐energy X‐ray absorptiometry (DXA). Alternatively in subjects over 50 years of age, the presence of a MTF is presumptive evidence of osteoporosis once other causes of bone fragility have been excluded (e.g. malignancy, osteomalacia, Pagets and osteogenesis imperfecta).2 In patients with chronic kidney disease (CKD) who suffer a MTF, the clinical problem is to differentiate between osteoporosis and the various forms of renal bone disease that are components of CKD–mineral and bone disorder. This problem is exacerbated by the possible coexistence of renal osteodystrophy and osteoporosis. Management of patients with CKD will differ if a MTF is due to osteoporosis as opposed to fractures due to renal bone disease. Differentiation between these conditions is therefore important to correctly manage the patient, and reduce the risk of subsequent fracture.
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