Bone biopsy in renal osteodystrophy

Abstract

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. 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. 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.