[Bone imaging in patient with chronic kidney disease: a new tool for managing renal osteodystrophy?]

Bone damage in patients with chronic kidney disease (CKD), in the spectrum of chronic kidney disease-mineral and bone disorders (CKD-MBD), represents a daily challenge for nephrologists. The impact of CKD on bone health may be immediate (biological equilibrium) or delayed (fractures and vascular calcifications). Histomorphometry remains the gold standard to evaluate bone but it is rarely perfomed in clinical practice. A real measurement of bone mineral density (BMD) by dual X-ray absorptiometry (DXA) is currently performed to evaluate bone mass. However, this technique presents some limitations. In 2000, the National Institute of Health (NIH) defined new "quality" criteria for the diagnosis of osteoporosis in addition to a decreased bone mass. Bone strength actually integrates two concepts: bone density and bone quality (i.e., microarchitectural organization, bone turnover, mineralization and microfractures). These quality criteria cannot be evaluated by DXA. New bone imaging techniques have thus been developed, leading to an improvement in bone evaluation.