How can I effectively monitor bone mineral density in patients with CKD-MBD, and what are the indications for treatment based on these results?

Monitoring bone mineral density (BMD) in patients with CKD-MBD: Routine measurement of calcium, phosphate, parathyroid hormone (PTH), and vitamin D levels is recommended in adults with a glomerular filtration rate (GFR) less than 30 ml/min/1.73 m2 (CKD stages G4 and G5), as these parameters are critical in assessing mineral and bone disorder in CKD. The frequency of testing should be determined by the measured values and clinical circumstances, with specialist advice sought if there is uncertainty.

Bone mineral density itself is not routinely measured in all CKD patients, but assessment for osteoporosis and fracture risk should be considered, especially in those with GFR ≥30 ml/min/1.73 m2 (G1 to G3), where bisphosphonates may be offered for prevention and treatment of osteoporosis if indicated.

Indications for treatment based on monitoring results: Bisphosphonates are recommended for adults with CKD stages G1 to G3 (GFR ≥30 ml/min/1.73 m2) if osteoporosis prevention or treatment is indicated.

Vitamin D supplementation is not routinely offered to manage or prevent CKD-MBD but should be given to treat vitamin D deficiency. If vitamin D deficiency is corrected and symptoms of CKD-MBD persist in patients with GFR <30 ml/min/1.73 m2, active vitamin D analogues such as alfacalcidol or calcitriol may be offered, with monitoring of serum calcium and phosphate concentrations during treatment.

Overall, management and monitoring should be individualized based on GFR category, biochemical markers, and clinical presentation, with referral to renal specialists when necessary.