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

Martins, Carolina Steller Wagner; Jorgetti, Vanda; Moysés, Rosa Maria Affonso

doi:10.1097/mnh.0000000000000418

Cited by 5 publications

(2 citation statements)

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“…Renal osteodystrophy diagnosis still relies on the performance of a bone biopsy because no serum or urinary biomarker has been shown to have an accurate performance . The foundation KDIGO (Kidney Disease: Improving Global Outcomes) currently recommends the use of the TMV classification (T = bone turnover, M = bone mineralization, V = bone volume) for the diagnosis of the different types of renal osteodystrophy …”

Section: Introductionmentioning

confidence: 99%

Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients

et al. 2020

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Bone biopsy is still the gold standard to assess bone turnover (T), mineralization (M), and volume (V) in CKD patients, and serum biomarkers are not able to replace histomorphometry. Recently, metabolomics has emerged as a new technique that could allow for the identification of new biomarkers useful for disease diagnosis or for the understanding of pathophysiologic mechanisms, but it has never been assessed in the chronic kidney disease-mineral and bone disorder (CKD-MBD) scenario. In this study, we investigated the association between serum metabolites and the bone TMV classification in patients with end-stage renal disease by using serum NMR spectroscopy and bone biopsy of 49 hemodialysis patients from a single center in Brazil. High T was identified in 21 patients and was associated with higher levels of dimethylsulfone, glycine, citrate, and N-acetylornithine. The receiver-operating characteristic curve for the combination of PTH and these metabolites provided an area under the receiver-operating characteristic curve (AUC) of 0.86 (0.76 to 0.97). Abnormal M was identified in 30 patients and was associated with lower ethanol. The AUC for age, diabetes mellitus, and ethanol was 0.83 (0.71 to 0.96). Low V was identified in 17 patients and was associated with lower carnitine. The association of age, phosphate, and carnitine provided an AUC of 0.83 (0.70 to 0.96). Although differences among the curves by adding selected metabolites to traditional models were not statistically significant, the accuracy of the diagnosis according to the TMV classification seemed to be improved. This is the first study to evaluate the TMV classification system in relation to the serum metabolome assessed by NMR spectroscopy, showing that selected metabolites may help in the evaluation of bone phenotypes in CKD-MBD.

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Section: Introductionmentioning

confidence: 99%

Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients

et al. 2020

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“… 18 Taking these data into account, information obtained through quantitative histomorphometric analysis of bone tissue may be help us to understand the mechanisms behind the assoication of bone abnormalities and clinical outcomes, which may be crucial to improve the manangement of bone disease. 9 , 19 Table 1 shows characteristics of ROD according to histomorphometric parameters. Osteoporosis might be present in any type of bone disease, with the exception of osteomalacia.…”

Section: Introductionmentioning

confidence: 99%

Bone biopsy in nephrology practice

Barreto

Costa²,

Reis

et al. 2018

J. Bras. Nefrol.

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Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its management is tailored by the type of bone lesion - of high or low turnover - that cannot be accurately predicted by serum biomarkers of bone remodeling available in daily clinical practice, mainly parathyroid hormone (PTH) and alkaline phosphatase (AP). In view of this limitation, bone biopsy followed by bone quantitative histomorphometry, the gold-standard method for the diagnosis of ROD, is still considered of paramount importance. Bone biopsy has also been recommended for evaluation of osteoporosis in the CKD setting to help physicians choose the best anti-osteoporotic drug. Importantly, bone biopsy is the sole diagnostic method capable of providing dynamic information on bone metabolism. Trabecular and cortical bones may be analyzed separately by evaluating their structural and dynamic parameters, thickness and porosity, respectively. Deposition of metals, such as aluminum and iron, on bone may also be detected. Despite of these unique characteristics, the interest on bone biopsy has declined over the last years and there are currently few centers around the world specialized on bone histomorphometry. In this review, we will discuss the bone biopsy technique, its indications, and the main information it can provide. The interest on bone biopsy should be renewed and nephrologists should be capacitated to perform it as part of their training during medical residency.

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Bisphosphonate utilization across the spectrum of eGFR

et al. 2020

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

Abstract: 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.

Cited by 5 publications

References 69 publications

Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients

Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients

Bone biopsy in nephrology practice

Bisphosphonate utilization across the spectrum of eGFR

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