**Author details**

Shozo Yano\*

between vascular calcification/ atherosclerosis and osteoporosis, so called bone-vascular relationship, hypertension and chronic obstructive pulmonary disease (COPD) also become aware of fracture risks. On the other hand, cortical bone thickness measured by HR-pQCT was reported to be the best predictor for hip fracture in CKD patients [64]. Since bone turnover markers such as P1NP and TRACP5b are risk factors for fracture independent of BMD in CKD patients, combination of BMD and bone turnover markers makes it possible to discriminate subjects with bone fragility [64]. Further studies are necessary to identify noninvasive assess‐

**Normal Kidney**

*Common Risk Factors*

*CKD‐MBD*

**Figure 2.** Mechanisms of elevated risk for fracture in CKD patients. Although precise mechanisms remain uncertain, CKD and osteoporosis have many common risk factors, and in addition, CKD progression is associated with increased risk for fracture probably due to bone loss as well as deterioration of bone quality. Aging, inflammation, renin-angio‐ tensin axis, oxidative stress, insulin resistance, hyperglycemia, AGEs, smoking, menopause, lack of exercise, homocys‐ teine, uremic toxins, ADMA, and FGF23 are possible candidates for the common factors, and at the same time, these

CKD is not a single disease but a kind of syndrome. Thus, hypertension, obesity, atheroscle‐ rosis, gout, nephrolithiasis and life style are highly linked to the pathogenesis and the development of CKD. Diabetic nephropathy and hypertensive nephropathy are commonly observed in CKD, and these are probably at high risk for fracture. Because prevalence of CKD and osteoporosis increases in parallel with age, aged people often suffer from both disorders. Nowadays, CKD has been established as a risk factor for fragility fracture independent of age

**CKD/ESKD**

**Normal Bone**

Loss of bone strength (loss of bone mass and deteriorated bone quality)

**Osteoporosis /Risk of fracture**

ment tools for fracture risk.

84 Updates in Hemodialysis

**Normal Vessels**

Medial Calcification (osteoblastic changes of vascular smooth muscle cells)

> **Vascular Calcification /Risk of CVD**

are thought to be involved in the development of vascular calcification.

**5. Conclusion**

Address all correspondence to: syano@med.shimane-u.ac.jp

Department of Laboratory Medicine, Shimane University Faculty of Medicine, Izumo city, Shimane, Japan
