Bone Abstracts

Background: Osteoporosis management in chronic kidney diseasemineral bone disorder (CKD-MBD) is challenging due to altered bone turnover, disordered mineral metabolism, and the high risk of denosumab-associated hypocalcaemia when creatinine clearance (CrCl) is 30 ml/min and patchy evidence base. Fragmented pathways between primary and secondary care further increase the risk of adverse events and missed fracture-prevention opportunities. To address this, a cross-speciality rheumatologyrenal, cross-trust (Mid and South Essex, Luton, and Oxford University Hospitals) virtual CKD-MBD multidisciplinary team (MDT) was established within the osteoporosis service in September 2024, supported by a locally developed denosumab safety pathway aligned with KDIGO principles. We report early outcomes from the first 10 complex patients reviewed.

Methods: This prospective service evaluation include first 10 consecutive referrals to 2-monthly MDT. MDT outputs included riskbenefit assessment, treatment recommendations, and clearly assigned monitoring responsibilities, communicated to primary care.

Results: Ten patients (mean age 82.6 years; 8 CrCl 15-30 and 2 15 ml/min). Denosumab initiated or continued in six-patients, two were redirected to zoledronate, and two deferred pending metabolic optimisation. Two patients sustained new fragility fractures. (Table 1)

Conclusion: Embedding a regular virtual CKD-MBD MDT within osteoporosis services enabled structured decision-making, safer denosumab use, and standardised monitoring. Denosumab was used in patients with renal impairment where treatment might previously have been deferred. This pathway-driven, cross-specialty model provides a replicable framework for improving safety and treatment optimisation in advanced CKD-associated osteoporosis.