CKD-Associated Osteoporosis: A Comprehensive Clinical Update

Objective: To provide an updated overview of the pathophysiology, diagnostic strategies, and treatment options for chronic kidney disease (CKD)-associated osteoporosis. Methods: A narrative review of recent literature and guideline recommendations, including KDIGO 2017 and 2025, with emphasis on bone health assessment and pharmacologic interventions in CKD. Results: CKD impairs bone quantity and quality through mechanisms involving uremic toxins, hormonal imbalances, metabolic acidosis, medications, and secondary hyperparathyroidism. While dual-energy X-ray absorptiometry (DXA) remains the standard for assessing bone mineral density, additional insights are provided by bone turnover markers, high-resolution peripheral quantitative computed tomography (HR-pQCT), and bone biopsy. Both antiresorptive and anabolic agents—such as bisphosphonates, denosumab, raloxifene, teriparatide, and romosozumab—demonstrate efficacy, though their uses must be carefully tailored, particularly in advanced CKD. Conclusion: Optimal management of osteoporosis in CKD requires individualized diagnostic and therapeutic strategies based on underlying pathophysiology.