title: Bone biopsy in renal osteodystrophy:  continued insights into a complex disease.
abstract: OBJECTIVE
  The pathogenesis and optimal therapy of renal bone disease remains poorly understood in chronic kidney disease (CKD) and dialysis patients. Bone biopsy is thus far the only window into cellular and molecular events in bone. This review will focus on recent insights into the pathophysiology of renal bone disease, as highlighted by bone biopsy, and discuss implications for treatment.
  
  
  RESULTS
  Abnormalities in bone physiology start very early in children and adults with CKD, when most clinically measurable mineral metabolism parameters are normal. In addition, racial differences, known to exist in serum markers such as parathyroid hormone, also appear prominent in the bone, suggesting that clinical treatment guidelines may not address the needs of all patient populations. The effects of treatments for secondary hyperparathyroidism on bone may be unexpected.
  
  
  CONCLUSIONS
  With the help of bone biopsy studies, molecular insights into the pathogenesis of renal osteodystrophy are beginning to emerge. Current therapies may have unexpected effects on bone physiology.
authors: Division of Nephrology, Beth Israel Deaconess Medical Center and Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA. mchrist3@bidmc.harvard.edu
authors: Marta
authors: M
authors: Christov
authors: Renata
authors: R
authors: Pereira
authors: Kate
authors: K
authors: Wesseling-Perry
mesh_terms: D001706:Biopsy; D001842:Bone and Bones / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis