People with serious kidney disease often have weak bones because their kidneys can’t control bone health properly. Researchers tested a new approach where doctors measured how fast bones were breaking down and building back up, then used that information to choose the best treatment. They studied 58 patients on dialysis (a treatment that cleans the blood when kidneys don’t work). The results showed that patients who received personalized treatment based on their bone turnover had stronger bones and better bone health markers after one year. This suggests doctors might be able to prevent broken bones in kidney disease patients by measuring bone activity and tailoring treatments accordingly.

The Quick Take

  • What they studied: Whether measuring how fast bones break down and rebuild in kidney disease patients could help doctors choose better treatments to strengthen bones
  • Who participated: 58 adults receiving dialysis treatment for kidney failure at one medical center between 2018 and 2024. Some had bone samples tested (31 patients) and others had special imaging scans (27 patients)
  • Key finding: Patients who received personalized treatment based on their bone turnover measurements had stronger bones in their forearms (wrists) after one year, with bone density improving by about 2% annually. Their bone breakdown markers also decreased significantly, suggesting bones were becoming healthier
  • What it means for you: If you have kidney disease and weak bones, doctors may soon be able to test how your bones are breaking down and use that information to pick treatments that work better for you personally. This could help prevent broken bones, though more research is needed to confirm these results work for everyone

The Research Details

This study looked at 58 patients with kidney failure who were receiving dialysis treatment. The researchers divided them into two groups: one group (31 patients) had small bone samples taken and tested in a lab to measure bone activity, while another group (27 patients) had special imaging scans called PET/CT that could show bone activity without needing a biopsy. Starting in 2020, the medical center introduced a new protocol where doctors used these bone activity measurements to decide which treatments each patient should receive. The researchers compared patients who followed this new personalized approach to patients treated before the protocol was introduced, tracking changes in bone strength and blood markers that show bone health over about one year.

The study design is important because it allowed researchers to see whether measuring bone turnover and using that information to guide treatment actually made a real difference in patient outcomes. By comparing patients treated with the new protocol to those treated the old way, they could determine if the personalized approach was better.

This research matters because kidney disease patients have a serious problem: their kidneys can’t control the minerals and hormones that keep bones healthy, leading to weak, fragile bones that break easily. The old approach was to give all patients similar treatments without knowing exactly what was happening in their bones. This new study shows that by measuring bone activity first and then choosing treatments based on those measurements, doctors can get better results. Understanding which patients have fast bone breakdown versus slow bone breakdown helps doctors pick the right medicine for each person, similar to how doctors test blood sugar before deciding on diabetes treatment.

This study has several strengths: it followed real patients over several years at an actual medical center, it used two different methods to measure bone activity (biopsies and imaging), and it compared results to a control group treated before the new protocol. However, there are some limitations to keep in mind. The study was done at only one medical center, so results might be different in other places. The sample size was relatively small (58 patients), which means the findings might not apply to all kidney disease patients. The study wasn’t randomized, meaning patients weren’t randomly assigned to treatment groups, which can introduce bias. The follow-up period was relatively short (one year), so we don’t know if benefits continue long-term or if bones eventually break less often.

What the Results Show

Patients who received personalized treatment based on bone turnover measurements showed meaningful improvements in bone strength. In the group that had bone biopsies, patients treated with the new protocol had bone density in their forearms increase by about 2% per year, compared to patients treated before the protocol was introduced (whose bones stayed about the same or got slightly weaker). This improvement was statistically significant, meaning it’s unlikely to have happened by chance.

Blood markers that indicate how fast bones are breaking down also improved dramatically. One marker called B-ALP decreased by 32%, and another called TRACP5b dropped by 48% in patients following the new protocol. In contrast, patients treated the old way showed no significant improvement in these markers. These changes suggest that the personalized treatment was actually slowing down the bone breakdown process.

In the group that had imaging scans instead of biopsies, patients with high bone turnover (bones breaking down too fast) showed even more impressive improvements. Their bone activity decreased by 17% in the hip area and 14% in the lower spine. Blood markers also improved significantly in this group, with B-ALP dropping 23% and TRACP5b falling 40%. Most importantly, patients whose bone turnover returned to normal levels had better bone density improvements at one year compared to those whose turnover stayed abnormal.

The study found that bone improvements were most noticeable in the forearm (distal radius), while changes at the spine, hip, and other areas were less dramatic. This suggests that different parts of the skeleton may respond differently to the personalized treatment approach. The research also showed that the imaging scan method (PET/CT) could provide useful information about bone activity without requiring a bone biopsy, which is important because biopsies are invasive and uncomfortable. Patients whose bone turnover normalized showed the best outcomes, suggesting that the goal of treatment should be to bring bone turnover back to normal levels rather than just lowering it.

Previous research in kidney disease patients has shown that weak bones are a major problem, but doctors haven’t had a clear way to decide which treatments work best for individual patients. Some studies suggested that measuring bone turnover might be helpful, but this is one of the first studies to actually test whether using these measurements to guide treatment decisions leads to better real-world outcomes. The findings support what smaller studies have suggested: that personalized, turnover-guided treatment may be more effective than one-size-fits-all approaches. The use of PET/CT imaging as an alternative to bone biopsy is also relatively new and represents a potential advance because it avoids the discomfort and risks of taking bone samples.

Several important limitations should be considered when interpreting these results. First, this was a single-center study at one medical facility, so the results might not apply to kidney disease patients at other hospitals or in different geographic regions. Second, the sample size was small (58 patients total), which limits how confident we can be in the findings. Third, the study wasn’t randomized, meaning patients weren’t randomly assigned to receive the new protocol or standard treatment, so there could be differences between groups that affected the results. Fourth, the follow-up period was only one year, so we don’t know if the improvements continue, get better, or fade over longer periods. Fifth, the study didn’t measure whether patients actually had fewer broken bones, which is the ultimate goal of treatment. Finally, the study didn’t include information about potential side effects or harms from the treatments used, which is important for a complete picture of safety.

The Bottom Line

Based on this research, kidney disease specialists may consider measuring bone turnover (through biopsy or imaging) to guide treatment decisions in patients with weak bones. This personalized approach appears to be more effective than standard treatment at improving bone health markers and bone density. However, these findings are preliminary and come from a single center, so doctors should use this information cautiously and consider it alongside other clinical factors. The evidence suggests this approach is worth trying, but it’s not yet strong enough to be considered standard care everywhere. Patients should discuss with their kidney disease doctor whether turnover-guided treatment might be appropriate for them.

This research is most relevant to adults with kidney failure who are receiving dialysis treatment and have been diagnosed with low bone density or weak bones. It may also be relevant to people with earlier stages of kidney disease who are developing bone problems. This research is less relevant to people with normal kidney function or those with bone problems from other causes. Patients who have already had bone fractures might benefit most from this approach. People considering dialysis or those newly started on dialysis should discuss bone health screening with their doctors.

Based on this study, improvements in bone density markers appeared within one year of starting personalized treatment. However, it typically takes several years to see meaningful reductions in fracture risk. Patients should expect to see improvements in blood markers (which indicate bone health) within 3-6 months, but bone density improvements may take 6-12 months to become apparent. The ultimate goal—actually preventing broken bones—would take longer to assess, potentially years. Patients should be prepared for ongoing monitoring and treatment adjustments rather than expecting quick fixes.

Want to Apply This Research?

  • Track bone turnover marker results (B-ALP and TRACP5b blood tests) every 3 months, recording the specific values and percentage changes. Users can set reminders for lab work appointments and log results directly in the app to visualize trends over time. This helps users and their doctors see whether treatment is working effectively.
  • Users should set reminders to take bone-health medications exactly as prescribed, since the study shows that consistent treatment following the protocol leads to better outcomes. The app could provide medication adherence tracking, send notifications before doses, and allow users to log when they’ve taken medications. Users could also log dietary calcium and vitamin D intake, which supports bone health alongside medical treatment.
  • Implement a long-term tracking dashboard showing bone density test results (DEXA scans) annually and blood marker results quarterly. Users should track any bone pain, falls, or fractures to identify patterns. The app could generate reports comparing current results to previous results, showing whether bone turnover is normalizing and bone density is improving. Users should also monitor kidney function markers since kidney health directly affects bone health. Set annual reminders for bone density screening and specialist appointments.

This research describes a specialized treatment approach for kidney disease patients with weak bones and should not be considered medical advice. The findings are from a single medical center with a small number of patients and have not yet been widely tested in other settings. If you have kidney disease and weak bones, discuss these findings with your nephrologist (kidney specialist) before making any changes to your treatment plan. This study measured bone health markers and density but did not track actual fracture rates, so the real-world benefit for preventing broken bones is not yet proven. Do not start, stop, or change any medications without consulting your doctor. Individual results may vary significantly from the study findings.