Diagnosis of renal osteodystrophy

Abstract

The idiom renal osteodystrophy (ROD) represents a heterogeneous pattern of bone disturbances caused by chronic renal insufficiency and concomitant diseases. For the clinical decision of therapy it is most important to differentiate between high and low or adynamic turnover ROD because the therapeutically consequences of these two ends of the ROD spectrum are fundamentally different. Bone histology remains the gold standard for the exact classification of ROD. Serological markers of bone metabolism are not suited for the accurate nomenclature of ROD but are useful for the sequential follow up of ROD after a clear diagnosis has been made. Similarly, radiological diagnosis of ROD using dual energy X-ray absorptiometry (DEXA) or quantitative computer tomography scan (q-CT) is inaccurate and thus more suited for the routine follow up of established disease.Besides mineralization, bone strength and the rate of fractures are strongly determined by the architecture of the bone matrix. This information, however, is also only available on bone biopsy sections and cannot be estimated by non-invasive diagnostic methods.In summary, bone biopsy should be used more liberally for correct classification of bone disease. The sequential follow up and guidance of therapy success can be performed by non-invasive procedures such as biochemical bone marker determination in blood. X-ray imaging and densitometry is suitable only for sequential evaluation of osteoporosis.

Vascular calcifications and renal osteodystrophy in chronic hemodialysis patients: what is the relationship between them?

“…Since 1943, when the term ''ROD'' was introduced [8], the diagnosis was based mostly on radiographic findings. Although numerous new diagnosis modalities such as PTH levels, bone mass density, and bone biopsy have been introduced in clinical practice [9][10][11], plain film radiography, especially fine quality hand radiography, still plays a role [12]. The main radiographic findings are induced by HPTH and are located especially in hands, clavicles, sacrum-iliac and pubic bones.…”

Bisphosphonate Use in Chronic Kidney Disease: Association with Adynamic Bone Disease in a Bone Histology Series

“…Bone histomorphometry, dynamic parameters fracture risk through changes in bone quality as well as quantity. Diagnosis of osteoporosis in CKD patients requires exclusion of osteodystrophy with bone biopsy, preferably with double tetracycline labeling [23,24] . The decision to treat CKD patients for DEXA-diagnosed osteoporosis presumes that 'areal' BMD is a true reflection of bone quantity, and that quantity is the principal determinant of bone strength and fracture risk.…”

Effect of aluminum on markers of bone formation resorption in chronic hemodialysis patients

“…Although bone biopsy with double tetracycline labeling to quantify bone formation rate is the criterion for diagnosis, noninvasive strategies such as the desferrioxamine (DFO) test [10,11] or markers of bone formation and resorption could be effectively used to evaluate Al intoxication and Al-induced bone disease [12][13][14][15][16][17][18][19][20]. The present study was conducted to explore the incidence and risk factors for Al intoxication and to assess a possible correlation between the bone markers and Al-induced bone diseases in chronic HD patients.…”