#3-33E. The Silent Link: Vertebral Fractures and Cardiovascular Risk in Advanced CKD (Nephrol Dial Transplant, 2025)

Are you overlooking a silent predictor of mortality in your dialysis patients? This episode reviews the 2025 consensus statement by Fusaro et al. regarding the management of vertebral fractures in CKD stages G4–G5D. The authors present a comprehensive clinical algorithm, urging clinicians to look beyond bone mineral density and recognize that vertebral fractures are frequently asymptomatic yet affect up to 50% of this population. Crucially, the paper underscores that vertebral fractures are not isolated skeletal events but are strongly associated with abdominal aortic calcification and myocardial infarction, serving as key prognostic markers for cardiovascular mortality. However, when critically appraising these recommendations, listeners must navigate the significant limitation that most osteoporosis therapies remain off-label for patients with an eGFR < 30 ml/min/1.73 m², as high-quality randomized trial data for fracture prevention in this specific subgroup are still lacking. This discussion is vital for nephrologists and primary care physicians, as it advocates for a paradigm shift towards active screening with lateral spine imaging, which could fundamentally alter risk stratification and management strategies for advanced CKD patients.

Citation: FUSARO, M. et al. A consensus statement on the management of vertebral fractures in CKD stages G4–G5D. Nephrology Dialysis Transplantation. Advance access, 2025. DOI: 10.1093/ndt/gfaf256

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.