The Role of Bone Biopsy in the Management of CKD-MBD and Osteoporosis

Excerpt

In the Osteoporosis section of the article [1], the authors used the term “CKD-associated osteoporosis”. Arguably, on pathophysiological grounds, the contribution of the kidney in the development of osteoporosis is rather minimal. Indeed, Osteoporosis and Renal Osteodystrophy have different starting points and at some stage, converge and then continue their parallel course, a common finding in the 3rd age group of patients. The term “CKD-associated osteoporosis” adds to the confusion because, although histologically Osteoporosis and Renal Osteodystrophy are two distinct entities, technically, according to the 2000 NIH definition [2], both are Osteoporosis as both are “characterized by compromised bone strength predisposing to an increased risk of fracture”. (Fig. 1) Taking this further, according to the operational WHO definition which is based on the level of bone mass, measured as BMD and expressed as a T-score [3], any T-score of − 2.5 or lower is reported as Osteoporosis.

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