Bisphosphonate Caution CKD G5D — ESENeph MCQ

Correct answer: A — Biochemical turnover assessment with possible bone biopsy

The best answer is “Biochemical turnover assessment with possible bone biopsy”. KDIGO individualises osteoporosis treatment in advanced CKD using fracture risk, calcium, phosphate, PTH, alkaline phosphatase and CKD trajectory. Bone biopsy is considered when turnover information would change treatment. “Treat from the T-score without considering bone turnover” is less appropriate because antiresorptive therapy may worsen adynamic bone disease “Exclude osteoporosis because the patient receives dialysis” is less appropriate because fracture risk and osteoporosis remain clinically important in dialysis “Give high-dose calcium despite hypercalcaemia and vascular calcification” is less appropriate because uncontrolled calcium loading can cause harm “Use active vitamin D to suppress the already low PTH further” is less appropriate because further PTH suppression can worsen low-turnover bone disease

Reference: KDIGO 2017 CKD-MBD guideline update: https://kdigo.org/wp-content/uploads/2018/04/2017-KDIGO-CKD-MBD-GL-Update.pdf