Histomorphometric Measurements of Bone Turnover, Mineralization, and Volume

Abstract

A recent Kidney Disease: Improving Global Outcomes report suggested that bone biopsies in patients with chronic kidney disease should be characterized by determining bone turnover, mineralization, and volume. This article focuses on the calculations and interpretation of these measurements. In most cases of renal osteodystrophy, the bone formation rate is roughly similar to the bone resorption rate; therefore, the bone formation indices can be used to describe turnover. It is important to remember that these conventions will not apply in some situations. Activation frequency should not be confused with bone formation rate or bone metabolic unit birth rate. Abnormal mineralization can be described using the osteoid volume, increased osteoid maturation time, or increased mineralization lag time. The concept of bone volume is the easiest to understand, but there is a large error from one biopsy to the next in the same person. There are some difficulties with each of the measurements, and further research in patients with chronic kidney must be done to enable a consensus to be reached about cut points to define categories within the spectrum of renal osteodystrophy and how to evaluate treatment responses.

Cancellous Bone Volume Is an Indicator for Trabecular Bone Connectivity in Dialysis Patients

“…However, the Kidney Disease: Improving Global Outcomes recently advocated the addition of cancellous bone volume (BV/TV) as a third major evaluation criterion for bone histology in CKD-MBD patients. The concept of this system, called turnover-mineralization-volume (TMV) classification (2,5), has become widely recognized.…”

Cinacalcet Decreases Bone Formation Rate in Hypercalcemic Hyperparathyroidism after Kidney Transplantation

“…Trabecular thickness usually relates to bone strength [33] and decreases with age [34]. Patients with typical hyperparathyroidism features have more and thicker but irregularly shaped trabeculas that are likely less strong [35,36].…”

Diagnosis and Treatment of Patients With Secondary Hyperparathyroidism and Renal Insufficiency. Therapeutic Potential of Paricalcitol

“…Уважаемая профессиональная ассоциация KDICO предложила использовать новую гистоморфометриче-скую классификацию -«обменно-минерализационный объем». Однако ввиду отсутствия валидизации в клинике новая классификация пока не применяется [19]. ВГПТ длительно протекает бессимптомно, и первые симптома-тические проявления, как правило, обусловлены значи-тельным поражением скелета.…”