title: Can one evaluate bone disease in chronic kidney disease without a biopsy?
abstract: OBJECTIVE
  Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a complex disorder of bone and mineral metabolism that results in an excess risk of fractures, cardiovascular events and mortality. The management of the bone disorder aspect 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.
  
  
  RESULTS
  Advances in imaging methods now permit the noninvasive 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 the risk of bone loss and fracture, but they are less useful in diagnosing the type of renal osteodystrophy.
  
  
  CONCLUSIONS
  Although advances in imaging now permit the assessment of fracture risk more accurately in CKD patients, the assessment of the type of renal osteodystrophy remains poor without bone biopsy. The virtual bone biopsy will be possible only when we are able to noninvasively assess turnover with good accuracy. A bone biopsy is needed when the bone turnover is unclear.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York, USA.
authors.forename: Revekka
authors.initials: R
authors.lastname: Babayev
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Nickolas
mesh_terms: D015502:Absorptiometry, Photon; D001706:Biopsy; D015519:Bone Density; D016723:Bone Remodeling / Q000502:physiology; D001842:Bone and Bones / Q000473:pathology* / Q000503:physiopathology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D008903:Minerals / Q000378:metabolism; D010018:Osteomalacia / Q000097:blood*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014057:Tomography, X-Ray Computed
chemical_list: D008903:Minerals