Diagnosis and monitoring of renal osteodystrophy

A variety of biochemical investigations and radiological techniques are available to assist in the diagnosis and monitoring of renal osteodystrophy. Measurement of serum parathyroid hormone remains the single most useful biochemical test in predicting bone histology in an individual patient. Newer biochemical markers of bone turnover are unlikely to supplant this in everyday practice, but may provide useful supplementary information in the future. The present review discusses the role of radiological investigation, including bone densitometry and quantitative ultrasound. Bone biopsy remains the 'gold standard' investigation. Its invasive nature and the need for specialized processing and interpretation limits its use in clinical practice, although it still has a role particularly in the investigation of low turnover states. Also, as molecular biological techniques are increasingly being used, the evaluation of biopsy specimens will in the future provide new insights into the disordered bone cell function that occurs in renal osteodystrophy.