Emerging role of high‐resolution imaging in the detection of renal osteodystrophy. Issue 10 (October 2016) - Sharma, Ashish K
Abstract: The term renal osteodystrophy refers to changes in bone morphology induced by chronic kidney disease (CKD) and represents the skeletal component of the entity 'chronic kidney disease – mineral and bone disorder'. Changes in turnover, mineralization, mass and microarchitecture impair bone quality, compromising strength and increasing susceptibility to fractures. Fractures are more common in CKD compared with the general population and result in increased morbidity and mortality. Screening for fracture risk and management of renal osteodystrophy are hindered by the complex, and still only partially understood, pathophysiology and the inadequacy of currently available diagnostic methods. Bone densitometry and bone turnover markers, although potentially helpful, have significant limitations in patients with CKD, and the 'gold standard' test of bone biopsy is infrequently performed in routine clinical practice. However, recent advances in high‐resolution bone microarchitecture imaging may offer greater potential for quantification and assessment of bone structure and strength and, when used in conjunction with serum biomarkers, may allow non‐invasive testing for a diagnostic virtual bone biopsy. Summary at a Glance: This is a review of the dilemmas and pitfalls of investigative modalities in their prediction of bone morphology in renal osteodystrophy and fracture risk in patients and an update on the emerging role of high resolution imagining in patients with chronic kidney disease.