ASN Live Update 2010; CKD -BMD or Osteoporosis

Is it Osteoporosis or CKD-BMD?  Miller Brent,MD
1. Fractures in CKD can be caused by CKD-BMD and osteoporosis
2. Clinical risk factors in CKD: chronic heparin use, hypoganadism, steroid exposure, increase prolactin, poor nutrition, Vitamin D def, secondary pth
3. KDIQO guidelines for osteoporosis in CKD-BMD
Stage 1-3  low bone mass or fracture noticed, more likely osteoporosis related than CKD-BMD
Stage IV-V bone biopsy might be necessary to differentiate
4. If bone specific Alk Phos is elevated, you can rule out osteoporosis, and adynamic bone disease as long Paget and malignancy has been ruled out
5. An elevated Pth ( 6 normal) excludes adynamic bone disease
6. A normal alkaline phosphatase, and normal to low pth cannot rule out adynamic bone disease
7. Gold standard would be Bone biopsy 
8. Is osteoporosis and CKD-BMD overalap, or is osteoporosis a part of CKD-BMD or is CKD-BMD a type of osteoporosis is not clear?