Bone metabolism and osteoporosis and CKD

Bone metabolism and osteoporosis :

• not recommend that there should be routine measurement of calcium, phosphate, parathyroid hormone (PTH) and vitamin D levels in people with stage 1, 2, 3A or 3B CKD
• measure serum calcium, phosphate and PTH concentrations in people with stage 4 or 5 CKD (GFR less than 30 ml/min/1.73 m2). Determine the subsequent frequency of testing by the measured values and the clinical circumstances. Where doubt exists seek specialist opinion
• bisphosphonates should be offered (if indicated) for the prevention and treatment of osteoporosis in people with stage 1, 2, 3A or 3B CKD
  
  
• Vitamin D supplements in the management of CKD-mineral and bone disorders
  • do not routinely offer vitamin D supplementation to manage or prevent CKD-mineral and bone disorders
  • offer colecalciferol or ergocalciferol to treat vitamin D deficiency in people with CKD and vitamin D deficiency
  • if vitamin D deficiency has been corrected and symptoms of CKD-mineral and bone disorders persist, offer alfacalcidol (1-alpha-hydroxycholecalciferol) or calcitriol (1-25-dihydroxycholecalciferol) to people with a GFR of less than 30 ml/min/1.73 m2 (GFR category G4 or G5)
  • monitor serum calcium and phosphate concentrations in people receiving alfacalcidol or calcitriol supplements

Reference:

• NICE (July 2014). Chronic kidney disease early identification and management of chronic kidney disease in adults in primary and secondary care