Time to rethink the use of bone biopsy to prevent fractures in patients with chronic kidney disease

Purpose of review The purpose of this review is to provide evidence to justify the use of bone biopsy data to guide decisions regarding fracture prevention in patients with chronic kidney disease (CKD). To date, no data can support the use of bone biopsy for this purpose. However, we believe that bone turnover, mineralization and volume (TMV) data might help decide, which therapy to use. Recent findings Previous bone biopsy-based prospective and intervention studies have used bone turnover as an outcome measure. Recent data have shown that bone volume (trabecular and cortical) and mineralization should also be evaluated. Moreover, crystal quality and osteocytic protein expression can be analyzed using bone fragments. Noninvasive analysis of bone volume and bone turnover markers can be performed during patient follow-up. Summary Only bone biopsy can provide information on the TMV parameters. Case reports and retrospective studies suggest that bone histomorphometric analysis can guide better therapeutic decisions to prevent fractures in patients with CKD. However, prospective data are still lacking.

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