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Bone metabolism and osteoporosis and CKD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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