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Can One Evaluate Bone Disease in CKD Without a Biopsy? #MMPMID24867672
Babayev R; Nickolas TL
Curr Opin Nephrol Hypertens 2014[Jul]; 23 (4): 431-7 PMID24867672show ga
Purpose: Chronic kidney disease ? mineral and bone disorder (CKD-MBD) is a complex disorder of bone and mineral metabolism that results in excess risk of fractures, cardiovascular events and mortality. Management of the bone disorder of CKD-MBD may require bone biopsy to determine appropriate treatment strategies. However, it is unclear when biopsy may be necessary and whether or not state-of-the art imaging and serologic testing can supplant the bone biopsy as a tool to assist with management decisions. Recent Findings: Advances in imaging methods now permit the non-invasive assessment of structural aspects of bone quality. Furthermore, common bone imaging tools, such as dual energy X-ray absorptiometry can be used to stratify for fracture risk. Circulating markers of bone turnover can be used to assess risk of bone loss and fracture, but they are less useful to diagnose type of renal osteodystrophy. Summary: Although advances in imaging now permit assessment of fracture risk more accurately in CKD patients, assessment of type of renal osteodystrophy remains poor without bone biopsy. The virtual bone biopsy will be possible only when we are able to non-invasively assess turnover with good accuracy. A bone biopsy is needed in settings of unclear bone turnover.
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Curr+Opin+Nephrol+Hypertens 2014 ; 23 (4): 431-7
