Are Physicians Ready to Prevent Osteoporotic Fractures in Hemodialysis Patients?

Dear Editor, Chronic kidney disease (CKD) is associated with many adverse outcomes including mineral and bone disorders. The prevalence of fractures among patients with CKD exceeds that of the general population, due to impairments in bone quantity, bone quality, and abnormalities of neuromuscular function with profound effects on morbidity and mortality. Type 2 diabetes mellitus (T2DM), that is a major cause of CKD, appears per se associated with an increased fracture risk despite a higher bone mineral density (BMD). The heavy burden of fractures in T2DM is much more due to poor bone quality than BMD, and bone quality is not detected by common diagnostic tools such as dual energy X-ray absorptiometry.