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Adynamic Bone Disease — ESENeph MCQ

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ModerateHaemodialysisAdynamic Bone DiseaseESENeph

A 70-year-old man on haemodialysis has PTH 15 pmol/L (reference 1.6-6.9), calcium 2.5 mmol/L, phosphate 1.3 mmol/L, and ALP is normal. He had a fragility fracture. What type of bone disease is most likely?

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Correct answer: D — Adynamic bone disease

Low-normal PTH (relative to CKD stage – KDIGO suggests PTH 2-9x upper normal for dialysis), normal ALP, and normal calcium/phosphate in a dialysis patient with fragility fracture is consistent with adynamic bone disease (ABD). ABD is characterised by low bone turnover with reduced osteoblastic and osteoclastic activity. It is increasingly common due to oversuppression of PTH with calcimimetics and active vitamin D. The fracture risk is elevated due to impaired bone remodelling.

Reference: KDIGO 2017 – CKD-MBD Guideline Update