An update on investigation and management of renal bone disease.

Purpose of review: Renal bone disease has significant detrimental effects on both cardiovascular and bone health. It is important to understand that the pathophysiologic mechanisms are different from traditional causes of bone disease; and thus, the monitoring and treatment of this disease process requires special attention. Although new guidelines are overdue, progress has been made in the treatment of hyperphosphatemia as well as investigational therapies for renal osteodystrophy.

Recent findings: At a time when the treatment of hyperphosphatemia in chronic kidney disease was once diet and phosphate binders, the novel agent tenapanor, an inhibitor of NHE3, has since been demonstrated to be effective in patients on dialysis as monotherapy or in conjunction with phosphate binders, potentially improving pill burden. Furthermore, the investigational treatment of osteoporosis in chronic kidney disease has expanded since bone mineral density testing has been adopted in practice in these populations.

Summary: New pathways for phosphate control are continually being investigated, changing practice patterns and quality of life for patients. Further research is needed in the safety and efficacy of antiresorptive and stimulatory bone agents to target the variety of mechanisms of osteoporosis; however, small studies appear promising and could change the way these patient populations are treated.