Changing the current terminology in medicine—Always a challenge
Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
Correspondence and offprint requests to: J. B. Cannata-Andia, Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Julián Clavería S/N. Oviedo 33006, Spain. Email: cannata{at}hca.es
Keywords: Mineral and Bone Disorders and CKD; Renal Osteodystrophy; CKD-MBD
Since 1943, when bone metabolic disorders associated with chronic kidney disease (CKD) were described as ‘Renal Osteodystrophy’ [1], the knowledge and scope of this disorder have experienced relevant changes and progress. The growth and the almost worldwide spread of renal replacement therapies (RRT) have largely contributed to the expansion and current daily use of this term among the medical community. As a result of changes in strategy, new active treatments and longer survival in RRT, the term ‘Renal Osteodystrophy’ began progressively gathering several bone-associated mineral disorders, clearly explained in the K/DIGO paper in this issue of NDT [2], expanding its meaning.
The first and classical definition of Renal Osteodystrophy included only a combination of bone histological lesions, such as secondary hyperparathyroidism, osteomalacia, osteosclerosis and osteoporosis [1]. By then, no specific biochemical parameters were available, thus the possibilities to translate this term in clinical practice was difficult. Later, the better knowledge of this disorder, the possibility of more precise measurements of bone metabolic parameters, mainly the availability of pasathormone (PTH) assays, and the introduction of undecalcified bone biopsies, were crucial in the understanding and dissemination of the term ‘Renal Osteodystrophy’. The combination of a few biochemical parameters such as serum calcium, phosphate, alkaline phosphatase and PTH, together with the X-ray of specific areas using appropriate techniques and the undecalcified bone biopsy, converted the term ‘Renal Osteodystrophy’ in a meaningful and useful clinical term. In fact, the histological classification of Renal Osteodystrophy in High and Low Bone Turnover forms and its reasonable correlation with PTH has brought the term extensively into use in clinical practice and it has been the main base for the therapeutic management of bone and metabolic disorders associated with CKD during the last two decades.
The first description of ‘Renal Osteodystrophy’ did not include two important associated conditions: vascular calcifications and bone fractures [3]. However, already, these two frequent findings were associated with bone and mineral disorders related to CKD. In fact, since the beginning of the expansion of dialysis as a current RRT, poor control of calcium and phosphate and extra osseous calcifications were described as associated clinical findings. As an example, in 1967, it was mentioned that ‘dialysis patients achieved a better control in several biochemical parameters but they were turning to stone’ [4].
The new definition, evaluation and classification proposed by the K/DIGO initiative is far more complete and covers in one concept all the mineral and bone disorders associated with CKD, such as laboratory and bone abnormalities, vascular calcifications and their hard outcomes; cardiovascular disease, fractures and mortality. That is the main strength of the concept and its great value for the future. However, there might be some practical limitations to spread its use.
First the well and widely used term ‘Renal Osteodystrophy’ is simpler than the new proposed term: ‘Chronic Kidney Disease-Mineral and Bone Disorder’ and its abbreviation, CKD-MBD. And secondly, there is a possible language barrier in the new terminology. Renal Osteodystrophy is a term that in almost all languages can be expressed using two simple words. On the contrary, the new proposed abbreviation, CKD-MBD, is less meaningful by itself than ‘Renal Osteodystrophy’ and it is difficult to ensure that it makes similar sense in different languages. The concept ‘Chronic Kidney Disease-Mineral Bone Disorder’ includes six words, its translation in several languages will imply the use of different words starting with others letters, thus the English abbreviation ‘CKD-MBD’ may lose part of its meaning and strength. For example, in Spanish the abbreviation of the same words will be ‘ERC-AMO’, far away from CKD-MBD. This simple but important fact can hinder the implementation of the terminology in ‘non English-speaking countries’.
The K/DIGO, and specifically the "Bone working group", has made great efforts to evaluate, redefine, classify and update the concept of ‘Renal Osteodystrophy’, a subject highly needed. The position statement from K/DIGO represents an important step forward, to better describe a broader clinical syndrome and a systemic disorder of mineral and bone metabolism secondary to CKD, which implies not only abnormalities in mineral and bone metabolism but also extra-skeletal manifestations. The worldwide adoption of the new recommendations will be useful in clarifying and enhancing international scientific and academic communication in English. However, as mentioned earlier, special efforts must be made in each language to render, this new concept in a few and meaningful words, to convert this new terminology into a handy and useful term to replace ‘Renal Osteodystrophy’.
Conflict of interest statement. None declared.
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*Member of the K/DIGO Bone Working group.
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 Top References |
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- Liu SH, Chu Hl. Studies of calcium and phosphorus metabolism with special reference to pathogenesis and effects of dihydrotachysterol (AT 10) and iron. Medicine (1943) 22:103–161.
- Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (K/DIGO). Kidney Int (2006) 69:1945–1953.[CrossRef][ISI][Medline]
- Cannata-Andía JB, Rodríguez García M, Carrillo-López N, Fernández Martín JL, Naves Díaz M, Díaz López JB. Vascular calcifications: pathogenesis, management and impact on clinical outcomes. J Am Soc Nephrol (2006) 17:S267–S273.
[Abstract/Free Full Text] - Stanbury SN, Lumb GA, Mawer EB. Osteodystrophy developing in the course of chronic renal failure. Arch Intern Med (1969) 124:274–281.[CrossRef][ISI][Medline]
Accepted in revised form: 17. 1.07
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