Italian Nephrologists Survey Reveals Treatment Gaps in CKD Bone Disease Management

Chronic kidney disease affects bone health through complex mineral and bone disorders, dramatically increasing fracture risk and mortality. Despite this serious complication, clinical guidance remains unclear, creating potential treatment gaps in patient care.

Researchers surveyed 89 Italian nephrologists about their practices in diagnosing and treating CKD-associated osteoporosis. The survey covered biomarker availability, treatment approaches across different CKD stages, and adherence to clinical guidelines.

Results showed heterogeneous access to diagnostic tools. While basic markers like parathyroid hormone and vitamin D were available in over 90% of laboratories, advanced biomarkers like fibroblast growth factor-23 and Klotho were only available in 64-74% of facilities. Treatment approaches varied significantly, with nearly half following KDOQI guidelines and others following KDIGO recommendations for parathyroid hormone targets.

Denosumab was the most commonly prescribed bone-protective medication across all CKD stages (22.5-28.1% of cases), while bisphosphonates were rarely used in advanced kidney disease due to safety concerns. Anabolic bone-building drugs were seldom prescribed. Vitamin D supplementation was widespread, with various forms used depending on CKD stage.

These findings reveal both progress and persistent challenges in CKD bone health management. While nephrologists are increasingly proactive about bone protection, inconsistent biomarker availability and varied treatment approaches suggest need for clearer clinical guidance and standardized diagnostic access.