Osteosarcopenia describes a subgroup of older people affected by osteoporosis and sarcopenia- a combination of low bone density (osteopenia/osteoporosis) and low muscle mass, strength, and/or functional capacity (sarcopenia). Chronic kidney disease (CKD) is a complex disease characterized not only by progressive renal dysfunction but also by its widespread impact on multiple organ systems, including the musculoskeletal (MSK) system.

CKD stages 3a-5D show reduced Bone Mineral Density and mechanical strength, which increases the fracture probability. Individuals with end-stage kidney disease (ESKD) are at two to three times higher risk of fracture than the general population. It has been known that the pathophysiology of osteosarcopenia in CKD is multifactorial, including disruptions in mineral metabolism, inflammation, endocrine dysfunction, and physical inactivity. CKD–mineral and bone disorder (CKD-MBD) causes changes in calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF-23), and vitamin D metabolism, which results in insufficient bone mineralization and raised fracture risk.

Apart from bone health issues, CKD also significantly impacts skeletal muscle mass. Patients with CKD often experience muscle wasting because of increased protein catabolism and lowered protein synthesis, processes exacerbated by uraemia and systemic inflammation. This muscle mass reduction is compounded by frailty and diminished physical activity, further increasing the risk of falls and fractures in this vulnerable population. The dual impact of impaired bone and muscle health emphasizes the importance of managing both conditions in patients with CKD.

Diagnosis remains challenging due to overlapping features and a lack of integrated screening tools. There is an urgent need for integrated assessment tools. Moreover, targeted therapeutic strategies, including mineral metabolism correction, resistance exercise, and anabolic interventions, should be used to mitigate osteosarcopenia's progression and improve patient outcomes in CKD.

In conclusion, osteosarcopenia represents a growing concern in aging CKD populations. Early diagnostic strategies and targeted interventions are crucial to mitigate its impact and lower healthcare costs. Greater clinical awareness and effective therapies are needed to enhance the quality of life for individuals affected by CKD and osteosarcopenia.

Source: Caldiroli L,Molinari P, D'Alessandro C, et al. Osteosarcopenia in Chronic Kidney Disease: An Overlooked Syndrome? Journal of Cachexia, Sarcopenia and Muscle. 2025;16(2):e13787. https://doi.org/10.1002/jcsm.13787