Adynamic bone disease — ESENeph MCQ

Correct answer: D — Low-turnover adynamic bone disease

The best answer is “Low-turnover adynamic bone disease”. Adynamic bone disease is a low-turnover state promoted by excessive calcium loading and PTH suppression. Management reviews active-vitamin-D therapy, calcium-based binders and calcium exposure rather than driving PTH lower. “Osteitis fibrosa cystica from severe secondary hyperparathyroidism” is less appropriate because that is a high-turnover lesion associated with markedly raised PTH “Paget disease of bone” is less appropriate because this does not explain dialysis-associated PTH suppression and diffuse low turnover “Osteomalacia caused by untreated vitamin-D deficiency” is less appropriate because active-vitamin-D exposure plus suppressed PTH with low turnover point to oversuppression rather than simple deficiency “Metastatic prostate cancer” is less appropriate because the biochemical and biopsy pattern provides a coherent CKD-MBD diagnosis

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