Bone biopsy and the diagnosis of renal osteodystrophy
- L Darryl Quarles, MD
L Darryl Quarles, MD
- Section Editor — Renal Osteodystrophy
- Director, Division of Nephrology
- Associate Dean for Research
- The University of Tennessee Health Science Center
Bone biopsy and histological evaluation of tetracycline-labeled bone is required for accurate stratification of bone diseases in chronic kidney disease (CKD). The indications for when to perform a bone biopsy and whether bone imaging and biomarkers can supplant histological assessment of bone are not clear.
There are five major types of bone disease that occur in patients with advanced chronic renal failure [1-4]:
●Predominant hyperparathyroid-mediated high-turnover bone disease (osteitis fibrosa [OF])
●Low-turnover osteomalacia (defective mineralization in association with low osteoclast and osteoblast activities)
●Mixed uremic osteodystrophy (MUO; hyperparathyroid bone disease with a superimposed mineralization defect)
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- Normal bone
- Severe osteitis fibrosa
- Mixed uremic osteodystrophy
- Low-turnover osteomalacia
- Adynamic bone disorder
- Aluminum deposition in bone
- TMV classification system
- Serum intact parathyroid hormone concentration
- Alkaline phosphatase
- Biochemical markers of bone resorption
- Imaging techniques
- Deferoxamine challenge
- Bone biopsy
- Guidelines and position statements
- Technique of bone biopsy
- SUMMARY AND RECOMMENDATIONS