Diagnosis of renal osteodystrophy among chronic kidney disease patients




The purpose of this review was to study the prevalence of and establish an association between biochemical markers and the underlying rate of bone turnover in renal osteodystrophy.


Using the PubMed database, we undertook a systematic review of literature using studies that included bone histology in combination with serum biochemical markers among chronic kidney disease (CKD) patients, published between 1985 and 2007. Studies having at least 3 of 7 serum biochemical markers were chosen for this review.


Of the dialysis patients who were recipients of 1,701 bone biopsies, 41% had hyperparathyroid bone disease, 5% had osteomalacia, and 33% had adynamic bone disease. Among CKD patients not on dialysis, of a total of 1,316 bone biopsies, 34% had hyperparathyroid bone disease, 19% had osteomalacia, and 8% had adynamic bone disease. Dialysis patients who had high-turnover bone disease compared with those with low bone turnover had significantly higher levels of parathyroid hormone, serum alkaline phosphatase, bone-specific alkaline phosphatase, and osteocalcin. A similar relationship was observed among CKD patients not on dialysis. There was significant individual variation in bone turnover biochemical markers.


A combination of serum biochemical markers might predict underlying renal osteodystrophy better than would individual biochemical markers. A predictive model using bone histology and biochemical markers can be developed in the future.