A search of factors determining bone quality in patients with chronic kidney disease

我们用现代临床研究方法证明了慢性肾脏病患者骨脆性增加的普遍观点。体内实验研究表明，全身矿物质代谢异常对骨脆性的贡献相当有限，而尿毒症毒素直接和可逆地改变骨材料特性，导致尿毒症状态下骨弹性力学性能的恶化，提出了与CKD-MBD明显不同的尿毒症骨质疏松症的疾病概念。尿毒症毒素直接修饰骨材料特性的概念不仅有助于改善慢性肾脏病患者骨的临床实践模式，而且可能为阐明老年性骨质疏松症的病理生理机制提供可能的新钥匙。

We proved the common view that a bone fragility increases in patients with chronic kidney disease by a modern clinical study method. In vivo experimental studies revealed that the contribution of abnormal systemic mineral metabolism to the bone fragility was quite limited while uremic toxins directly and reversibly modified bone material properties that lead a deterioration of bone elastic mechanical properties in uremic condition.From these findings, we proposed a new disease concept of "uremic osteoporosis", which is clearly distinct from CKD-MBD. The concept of direct modification of bone material properties by uremic toxins would not only help improving the clinical practice pattern on bone in patients with chronic kidney disease, but also provide a possible new key to elucidate the pathophysiology of senile osteoporosis.