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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Orthop. Apr 18, 2026; 17(4): 115663
Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.115663
Kidney-bone axis: Emerging paradigms in cross-talk between renal function and skeletal health
Guido Gembillo, Concetto Sessa, Luca Visconti, Andrea Corsonello, Antonino Catalano, Chiara Chinigò, Salvatore Silipigni, Maria Princiotto, Maria Elsa Gambuzza, Giuseppe Spadaro, Walter Morale, Luca Soraci, Domenico Santoro
Guido Gembillo, Giuseppe Spadaro, Domenico Santoro, Department of Clinical and Experimental Medicine, Department of Nephrology and Dialysis, AOU “G. Martino”, University of Messina, Messina 98100, Sicilia, Italy
Concetto Sessa, Walter Morale, Department of Nephrology and Dialysis, Maggiore Nino Baglieri Hospital, Modica 97015, Sicilia, Italy
Luca Visconti, Unit of Nephrology and Dialysis, Ospedali Riuniti Villa Sofia Cervello, University of Palermo, Palermo 90146, Sicilia, Italy
Andrea Corsonello, Unit of Geriatric Medicine, IRCCS INRCA, Cosenza 87100, Calabria, Italy
Antonino Catalano, Unit and School of Geriatrics, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina 98125, Sicilia, Italy
Chiara Chinigò, Italian National Research Center on Aging, Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Cosenza 87100, Calabria, Italy
Salvatore Silipigni, Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina 98121, Sicilia, Italy
Maria Princiotto, Laboratory of Pharmacoepidemiology and Biostatistics, Italian National Research Center on Aging, Cosenza 87100, Calabria, Italy
Maria Elsa Gambuzza, Territorial Office of Messina, Ministry of Health, Messina 98125, Sicilia, Italy
Luca Soraci, Unit of Nephrology and Dialysis, Ospedali Riuniti Villa Sofia Cervello, University of Palermo, Palermo 90146, Calabria, Italy
Author contributions: Gembillo G, Sessa C, Visconti L, and Corsonello A contributed to the literature search; Gembillo G, Sessa C, Catalano A, Silipigni S, and Santoro D contributed to conceptualization; Chinigò C, Princiotto M, Gambuzza ME, and Spadaro G contributed to study selection; Gembillo G, Sessa C Morale W, Soraci L, and Santoro D contributed to manuscript drafting; and all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Guido Gembillo, MD, PhD, Department of Clinical and Experimental Medicine, Department of Nephrology and Dialysis, AOU “G. Martino”, University of Messina, Via Consolare Valeria n 1, Messina 98100, Sicilia, Italy. gembillog@unime.it
Received: October 22, 2025
Revised: November 23, 2025
Accepted: February 3, 2026
Published online: April 18, 2026
Processing time: 169 Days and 24 Hours
Core Tip

Core Tip: The kidney-bone axis represents a bidirectional endocrine network extending beyond mineral metabolism. Chronic kidney disease affects hundreds of millions worldwide, causing substantially elevated fracture risk and mortality. Traditional biomarkers provide incomplete prognostic value, necessitating novel approaches. The fibroblast growth factor-klotho pathway emerges as a critical mechanism regulating phosphate homeostasis, bone turnover, and cardiovascular complications, with alterations appearing early in disease progression. Understanding these integrated molecular pathways enables a paradigm shift from symptomatic management toward mechanism-based interventions, offering transformative potential for targeted therapies that simultaneously address skeletal fragility and systemic complications in chronic kidney disease-mineral and bone disorder.