title: When, how, and why a bone biopsy should be performed in patients with chronic kidney disease.
abstract: In chronic kidney disease the excessive production of parathyroid hormone increases the bone resorption rate and leads to histologic bone signs of secondary hyperparathyroidism. However, in other situations, the initial increase in parathyroid hormone and bone remodeling may be slowed down excessively by a multitude of factors including age, ethnic origin, sex, and treatments such as vitamin D, calcium salts, calcimimetics, steroids, and so forth, leading to low bone turnover or adynamic bone disease. Both high and low bone turnover diseases actually are observed equally in chronic kidney disease patients treated by dialysis, and all types of renal osteodystrophy are associated with an increased risk of skeletal fractures, reduced quality of life, and poor clinical outcomes. Unfortunately, the diagnosis of these bone abnormalities cannot be obtained correctly by current clinical, biochemical, and imaging methods. Therefore, bone biopsy has been, and still remains, the gold standard analysis for assessing the exact type of renal osteodystrophy. It is also the unique way to assess the mechanisms of action, safety, and efficacy of new bone-targeting therapies.
authors.affiliation: Service of Nephrology and Dialysis, Clinique du Landy and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France. Electronic address: urena.pablo@wanadoo.fr.
authors.forename: Pablo Ureña
authors.initials: PU
authors.lastname: Torres
authors.affiliation: Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinRen, Barcelona, Catalonia, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bover
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mazzaferro
authors.affiliation: Service of Rheumatology, Center Viggo Petersen, Lariboisière Hospital, Paris, France.
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: de Vernejoul
authors.affiliation: Service of Rheumatology, Center Viggo Petersen, Lariboisière Hospital, Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Cohen-Solal
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D001862:Bone Resorption / Q000209:etiology; D001842:Bone and Bones / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology; D008670:Metals / Q000097:blood; D018579:Patient Selection; D011300:Preoperative Care; D011859:Radiography; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*
chemical_list: D008670:Metals
keywords: Chronic kidney disease; adynamic bone disease; aluminum; bone biopsy; hyperparathyroidism; parathyroid hormone; renal osteodystrophy