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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

PTH Analog Therapy in CKD G4–G5D: Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease

by
Laia Gifre
1,*,
Maria Fusaro
2,3,
Maria J. Lloret
4,
Elisabet Massó
5,
Pilar Peris
6,
Xavier Nogués
7,
Rosana Gelpi
5,
Águeda Prior-Español
1,
Jordi Ara
5,
Mario Cozzolino
8,
Pablo A. Ureña-Torres
9,10 and
Jordi Bover
5
1
Rheumatology Department, Hospital Germans Trias i Pujol, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, C/Canyet S/N, 08196 Badalona, Spain
2
Department of Medicine, University of Padova, 35122 Padova, Italy
3
Institute of Clinical Physiology (IFC), National Research Council (CNR), 00185 Pisa, Italy
4
Nephrology Department, Fundació Puigvert, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
5
REMAR-IGTP Group, RICORS 2040, Nephrology Department, Research Institute Germans Trias i Pujol (IGTP), University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08196 Badalona, Spain
6
Rheumatology Department, Hospital Clínic Barcelona, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
7
Internal Medicine Department, Hospital del Mar Research Institute, CIBER de Envejecimiento y Fragilidad Saludable, Universitat Pompeu Fabra, 08003 Barcelona, Spain
8
Renal Division, Department of Health Sciences, University of Milan, 20122 Milan, Italy
9
Department of Nephrology and Dialysis, AURA Nord Saint-Ouen, 93400 Saint-Ouen, France
10
Department of Renal Physiology, Necker Hospital, University of Paris Descartes, 75015 Paris, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(1), 133; https://doi.org/10.3390/jcm15010133
Submission received: 15 November 2025 / Revised: 17 December 2025 / Accepted: 22 December 2025 / Published: 24 December 2025
(This article belongs to the Section Nephrology & Urology)
Versions Notes

Abstract

Osteoporosis and fragility fractures are among the most prevalent and clinically significant complications in patients with chronic kidney disease (CKD), particularly in stages G4–G5 and in those undergoing dialysis (G5D). These skeletal disorders are associated with markedly increased morbidity and mortality, including a 2- to 9-fold higher risk of hip fractures compared to the general population, prolonged hospitalization, functional decline, and excess postoperative mortality. Despite this substantial burden, CKD-associated osteoporosis remains underrecognized and undertreated. Limited inclusion of CKD patients in pivotal osteoporosis trials and the absence of high-evidence guidance in clinical guidelines have contributed to a persistent therapeutic gap. PTH analog agents such as teriparatide and abaloparatide have demonstrated robust efficacy in increasing bone mass and reducing fracture risk in the general population. However, their use in CKD remains limited. PTH analog are poorly prescribed in patients with CKD stage G3 and remain off-label for stages G4–G5D, despite the high prevalence of adynamic bone disease across all stages of CKD. Abaloparatide, a selective PTH1 receptor agonist, exerts potent anabolic effects with a lower incidence of hypercalcemia than teriparatide and may offer a favourable safety profile in carefully selected patients. Preliminary data suggest preservation of bone microarchitecture and potential benefits in low-turnover bone disease, although evidence in CKD is still limited. This narrative review examines current evidence on abaloparatide’s potential role in CKD, emphasizing its mechanism of action, efficacy, safety, and relevance for patients with low bone turnover and high fracture risk.
Keywords: chronic kidney disease; CKD-MBD; adynamic bone disease; osteoporosis; fragility fractures; bone turnover; bone-forming therapies; Abaloparatide chronic kidney disease; CKD-MBD; adynamic bone disease; osteoporosis; fragility fractures; bone turnover; bone-forming therapies; Abaloparatide

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MDPI and ACS Style

Gifre, L.; Fusaro, M.; Lloret, M.J.; Massó, E.; Peris, P.; Nogués, X.; Gelpi, R.; Prior-Español, Á.; Ara, J.; Cozzolino, M.; et al. PTH Analog Therapy in CKD G4–G5D: Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease. J. Clin. Med. 2026, 15, 133. https://doi.org/10.3390/jcm15010133

AMA Style

Gifre L, Fusaro M, Lloret MJ, Massó E, Peris P, Nogués X, Gelpi R, Prior-Español Á, Ara J, Cozzolino M, et al. PTH Analog Therapy in CKD G4–G5D: Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease. Journal of Clinical Medicine. 2026; 15(1):133. https://doi.org/10.3390/jcm15010133

Chicago/Turabian Style

Gifre, Laia, Maria Fusaro, Maria J. Lloret, Elisabet Massó, Pilar Peris, Xavier Nogués, Rosana Gelpi, Águeda Prior-Español, Jordi Ara, Mario Cozzolino, and et al. 2026. "PTH Analog Therapy in CKD G4–G5D: Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease" Journal of Clinical Medicine 15, no. 1: 133. https://doi.org/10.3390/jcm15010133

APA Style

Gifre, L., Fusaro, M., Lloret, M. J., Massó, E., Peris, P., Nogués, X., Gelpi, R., Prior-Español, Á., Ara, J., Cozzolino, M., Ureña-Torres, P. A., & Bover, J. (2026). PTH Analog Therapy in CKD G4–G5D: Current Evidence and Potential Role of Abaloparatide in Adynamic Bone Disease. Journal of Clinical Medicine, 15(1), 133. https://doi.org/10.3390/jcm15010133

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