Kidney Week

Abstract: FR-PO0242

Clinical Risk Factors for CKD-Associated Osteoporosis: Insights from the Brazilian Registry of Bone Biopsy (REBRABO)

Session Information

• Bone and Mineral Metabolism: Clinical Epidemiology and Outcomes
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Lowe, Lauren S, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States

Lauren S Lowe

• Carbonara, Cinthia Esbrile Moraes, Universidade Estadual de Campinas, Campinas, SP, Brazil

Cinthia Esbrile Moraes Carbonara, MD, PhD

• Oliveira, Rodrigo Bueno, Universidade Estadual de Campinas, Campinas, SP, Brazil

Rodrigo Bueno Oliveira, MD, PhD

• Nickolas, Thomas L., Washington University in St Louis, St. Louis, Missouri, United States

Thomas L. Nickolas, MD, MS, FASN

• Elias, Rosilene M., Universidade de Sao Paulo, São Paulo, SP, Brazil

Rosilene M. Elias, MD, PhD

• Jorgetti, Vanda, Universidade de Sao Paulo, São Paulo, SP, Brazil

Vanda Jorgetti, MD, PhD

• dos Reis, Luciene, Universidade de Sao Paulo, São Paulo, SP, Brazil

Luciene dos Reis, PhD

• Carvalho, Aluizio B., Universidade Federal de Sao Paulo, São Paulo, SP, Brazil

Aluizio B. Carvalho, MD, PhD

• Yin, Michael T., Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States

Michael T. Yin, MD

• Moyses, Rosa M.A., Universidade de Sao Paulo, São Paulo, SP, Brazil

Rosa M.A. Moyses, MD, PhD

• Duque, Eduardo Jorge, Universidade de Sao Paulo, São Paulo, SP, Brazil

Eduardo Jorge Duque, MD, PhD

Background

Chronic kidney disease-associated osteoporosis (CKD-OP) is characterized by impaired bone quality and an increased risk of fractures. Management of bone fragility in CKD partially relies on evaluating bone turnover (T), mineralization (M), and volume (V)— TMV—through bone biopsy. However, bone biopsy data from large population-based cohorts are limited, making it challenging to identify clinical and laboratory parameters that reliably predict TMV patterns.

Methods

This cross-sectional study is based on data from the Brazilian Registry of Bone Biopsy (REBRABO) and includes 374 iliac crest bone biopsies from adult patients with CKD5D (median age = 52 y), collected between Aug 2015-Dec 2021. Each biopsy was classified according to trabecular bone T (low/normal vs. high), M (normal vs. abnormal), and V (normal vs. low). Demographic and laboratory parameters were also analyzed.

Results

No significant differences in TMV classification were observed based on ethnicity, sex, or diabetes status. Higher T was independently associated with younger age, dialysis modality, elevated parathyroid hormone (PTH), and alkaline phosphatase (ALP) levels, in a model adjusted for dialysis vintage, prior parathyroidectomy (PTX), serum phosphate, and hemoglobin. Abnormal M was independently associated with older age, prior PTX, and lower serum calcium and phosphate, after adjustment for body mass index (BMI), PTH, and ALP. Low trabecular V was independently associated with older age and lower BMI, in a model adjusted for PTH and history of fractures. Notably, most patients with adynamic bone disease (ABD) also presented with low trabecular volume.

Conclusion

Lower trabecular bone volume cannot be reliably inferred from biochemical markers, is more prevalent in older patients, and is more commonly associated with ABD in individuals with CKD5D. In patients with low trabecular bone T, reduced trabecular bone V may reflect a diminished bone formation rate, highlighting the need for personalized management strategies in CKD-OP.

Funding

• Other NIH Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025kptb8f2g