Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy

Renal osteodystrophy, in which abnormalities of bone turnover predominate, continues to be a complication of CKD and is associated with morbidity and poor quality of life. There is a need to assess the current status and distribution of the types of renal osteodystrophy and to define appropriate therapeutic targets. Bone biopsy remains the gold standard in the diagnosis of the precise type of pathologic changes of bone turnover. There is also a need to standardize bone histology and biopsy techniques and to refine the targets for biochemical parameters that will allow more accurate noninvasive assessment of skeletal activity. Enhanced understanding of the differences in renal osteodystrophy in children compared to adults is needed. The use of newer vitamin D analogs such as paricalcitol may result in improved patient outcomes compared to therapy with the native hormone, calcitriol. Such studies need to be confirmed and extended. Novel compounds such as the calcimimetics may provide additional therapeutic approaches to control hyperparathyroidism with minimum calcium toxicity.