Managing Musculoskeletal and Kidney Aging: A Call for Holistic Insights

Abstract

Aging represents a major concern, with a two-fold increase in individuals >65 years old by 2040. Older patients experience multiple declines in condition, with overlapping concerns. Fractures, frailty and falls remain underestimated events in routine practice. They are shared by numerous conditions and diseases, such as osteoporosis, sarcopenia and undernutrition, which mostly feature low evolution and are silent. In this review, we focused on musculoskeletal decline in older individuals who also have chronic kidney disease (CKD), which promotes fractures and falls. We aimed to highlight the need for a global approach for musculoskeletal and kidney aging. Although strategies limiting falls remain controversial, the need for an early diagnosis can limit these declines and allow for specific treatment of bone fragility in addition to non-pharmacological approaches. The emergence of senolytic agents offers new hope for preventing musculoskeletal disorders. This scoping review describes these overlapping silent diseases, provides evidence for their global understanding and management, and sheds light on new therapeutic directions.

Keywords:

• older individuals
• osteoporosis
• sarcopenia
• kidney disease
• senolytics

Concise Methodology

In this review, we first performed an electronic search from January 1980 to February 2020 using MEDLINE (PubMed) for original works and expert report. An iterative approach included 2 equations with the following MeSH terms: “Fracture” + “Chronic kidney disease”; “Bone” +” Elderly” +”Chronic Kidney Disease”. The first reviewer (PEC) screened the titles and abstracts according to these keywords criteria. Then, the selection was transferred to the second reviewer (MCS) who refined and confirmed the selection. The two reviewers then performed a more careful reading of the manuscripts and selected the most relevant papers to their aim. We also added guidelines of international and national societies as well as relevant review articles in order to illustrate positions in case scientific data are not available. A narrative synthesis of each organ failure was conducted, aiming to describe the evidence and limitations for the diagnosis for each tissue insufficiency. We then analyzed the literature in the light of concomitant diseases and identify the needs for further research.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Pierre-Emmanuel Cailleaux declares that he has no competing interest.

Martine Cohen-Solal declares that she has no competing interest.