Biomarkers Predicting Bone Turnover in the Setting of CKD

Abstract

Studies exploring the performance of established and emerging bone biomarkers against histomorphometric assessment of bone turnover are limited and overall yield inconclusive results as to their diagnostic utility. Bone biomarkers, although promising, currently fail to meet the needed diagnostic accuracy to replace bone histomorphometry and thus are not yet ready for clinical use. Bone biomarkers have not only several advantages, but also important limitations such as high biological variability, retention with kidney disease, preanalytical issues, and interassay variability. These important issues must be considered when developing and evaluating bone biomarkers. There is an urgent need for harmonization and standardization of available assays and additional bone biopsy studies.

Bone mineral density, bone turnover markers, and incident fractures in de novo kidney transplant recipients

“…Bone turnover markers (BTMs) have been suggested as surrogate of or adjuvant to bone biopsy to assess bone turnover. 6 There is growing evidence that aBMD may both discriminate fracture status 7 and predict incident fractures in CKD patients as in the general population. 8,9 Also in renal transplant recipients, preliminary data indicate that a low aBMD may predict fractures.…”

High turnover renal osteodystrophy due to secondary hyperparathyroidism diagnosed by 18F-Fluorocholine combined with 18F-NaF PET/CT

“…Given the invasiveness of the operation and the limited availability of specimen collection and interpretation of results. Clinically, the detection of the levels of serum bone turnover markers, calcium, phosphorus, ALP and PTH as well as the trend of change in serum PTH combined with bone density examination has become a common method for noninvasive diagnosis of ROD [2][3], but the above method are not enough to estimate the classification of bone turnover in ROD. 18 F-NaF PET/CT whole-body bone imaging can not only assess the overall metabolism of the whole body bone, but also reveal local bone abnormalities.…”

Division of an Iliac Crest Bone Biopsy Specimen to Allow Histomorphometry, Immunohistochemical, Molecular Analysis, and Tissue Banking: Technical Aspect and Applications

“…(8) Because standard bone markers are not reliable enough to estimate bone turnover level in CKD, bone histomorphometry analyses thus provide nephrologists essential information on the type of bone disease to guide anti-fracture therapy. (10,11) However, its invasiveness and highly specialized nature restricts its wide utilization. (12) Recently, circulating micro-RNA has been suggested as promising biomarkers of bone turnover level in CKD, but further larger studies are needed to evaluate their potential use in patients.…”