만성 신장질환(CKD)은 근골격계를 포함해 여러 기관 시스템을 무너뜨린다. 미네랄 대사, 비타민 D 활성화, 호르몬 조절의 교란은 골소실과 근감소를 모두 가속한다. 두 가지가 동시에 발생하는 '골근감소증'은 낙상, 골절, 입원, 독립성 상실 위험을 극도로 높인다. *Frontiers in Endocrinology*에 발표된 횡단면 조사는 대부분의 CKD 환자가 이 복합 위협을 거의 알지 못함을 보여줬다.
지식·태도·행동 격차
지식: 많은 환자가 골근감소증 개념에 생소하고, CKD가 뼈·근육 손실을 가속화한다는 사실을 설명하는 환자가 드물었다.
태도: 대부분 신장 질환이 심각하다고 인식하지만, 근골격계 건강과 자발적으로 연결하지 못했다. '어차피 할 수 있는 게 없다'는 숙명론적 태도도 흔했다.
행동: 신체 활동 수준이 낮고 저항 운동을 하는 환자가 적었다. 식이 단백질 섭취도 불충분했다.
CKD 환자가 알아야 할 것
골근감소증 예방을 위한 핵심 행동으로는 신기능 단계에 맞춘 저항·체중 부하 운동, 충분한 단백질 섭취(신장 전문의 지도 하에), 비타민 D 보충, 낙상 예방, 정기적 골밀도·악력 검사가 있다.
신장 전문팀은 정기 진료 시 골근감소증 교육을 통합함으로써 환자 자기 관리를 향상하고 골절 발생률을 줄일 수 있다.
*출처: Yang C 외. Front Endocrinol (Lausanne), 2026.*
Chronic kidney disease (CKD) devastates multiple body systems, including the musculoskeletal system. Disruptions in mineral metabolism, vitamin D activation, and hormonal regulation accelerate both bone loss (osteoporosis) and muscle wasting (sarcopenia) in CKD patients. When both occur together — osteosarcopenia — the risk of falls, fractures, hospitalization, and loss of independence becomes extremely high. A cross-sectional survey published in *Frontiers in Endocrinology* reveals that most CKD patients know little about this combined threat.
Survey Findings: Knowledge, Attitude, Practice Gaps
Yang and colleagues surveyed CKD patients on their knowledge of osteosarcopenia, their attitudes toward prevention and management, and their actual behaviors related to exercise, nutrition, and supplementation.
Knowledge: Many patients were unfamiliar with osteosarcopenia as a concept. Few could articulate how kidney disease specifically accelerates bone and muscle loss. Knowledge deficits were more pronounced in patients with lower education levels and earlier CKD stages.
Attitudes: While most patients acknowledged that kidney disease is serious, they did not spontaneously link it to musculoskeletal health. Fatalistic attitudes — "there's nothing I can do" — were common.
Practices: Physical activity levels were low, with few patients engaging in resistance exercise. Dietary protein intake was often insufficient. Supplement use was inconsistent and not always evidence-guided.
What CKD Patients Should Know
Key protective behaviors for osteosarcopenia in CKD include: engaging in regular resistance and weight-bearing exercise (tailored to kidney function stage); maintaining adequate protein intake (with nephrologist guidance on appropriate levels); vitamin D supplementation; fall prevention strategies; and regular bone density (DEXA) and grip strength assessments.
Implications
Nephrology teams have a critical opportunity to integrate osteosarcopenia education into routine CKD consultations. Patient empowerment through knowledge can directly translate into better self-management behaviors, reduced fracture incidence, and improved quality of life.
*Source: Yang C, Wei W, Chai W, Li T, Ma Y. Front Endocrinol (Lausanne), 2026.*
