title: Value of the new bone classification system in pediatric renal osteodystrophy.
abstract: OBJECTIVE
  Although lesions of renal osteodystrophy have traditionally been defined by bone turnover, alterations in skeletal mineralization and volume are also prevalent and may contribute to significant morbidity in patients with chronic kidney disease (CKD). The study presented here was undertaken to compare the traditional spectrum of renal osteodystrophy defined by bone turnover to a new classification system that includes T (turnover), M (mineralization), and V (volume) and to determine the value of biochemical parameters as predictors of specific TMV lesions.
  
  
  METHODS
  Pediatric patients (n = 161) treated with peritoneal dialysis were enrolled into the study.
  
  
  RESULTS
  Increased bone turnover and abnormal mineralization were prevalent (57% and 48%, respectively); bone volume was normal or increased in all subjects. Predictive algorithms for different skeletal diagnoses were established by Classification and regression tree analysis. Serum parathyroid hormone (PTH) less than 400 pg/ml in combination with alkaline phosphatase values less than 400 IU/L provided the highest correct prediction rate for patients with both normal bone turnover and normal mineralization. Levels of PTH were higher and serum calcium levels were lower in patients with defective mineralization, irrespective of bone turnover.
  
  
  CONCLUSIONS
  Although no single biochemical marker is able to provide a complete assessment of renal osteodystrophy, a combination of serum calcium, alkaline phosphatase, and PTH levels may lead to a more precise noninvasive assessment of turnover and mineralization abnormalities in this population.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California, USA. sevcan@gazi.edu.tr
authors.forename: Sevcan A
authors.initials: SA
authors.lastname: Bakkaloglu
authors.forename: Katherine
authors.initials: K
authors.lastname: Wesseling-Perry
authors.forename: Renata C
authors.initials: RC
authors.lastname: Pereira
authors.forename: Barbara
authors.initials: B
authors.lastname: Gales
authors.forename: He-Jing
authors.initials: HJ
authors.lastname: Wang
authors.forename: Robert M
authors.initials: RM
authors.lastname: Elashoff
authors.forename: Isidro B
authors.initials: IB
authors.lastname: Salusky
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016723:Bone Remodeling; D002113:Calcification, Physiologic; D002118:Calcium / Q000097:blood; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007085:Ilium / Q000378:metabolism / Q000473:pathology*; D007223:Infant; D015141:Los Angeles; D008297:Male; D009929:Organ Size; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D012044:Regression Analysis; D009626:Terminology as Topic; D055815:Young Adult
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase; D002118:Calcium