Advances in noninvasive diagnosis of renal osteodystrophy

Renal osteodystrophy (ROD) refers to the histological abnormalities in bone associated with chronic kidney disease (CKD), closely linked to the progression of CKD, increased risk of fractures, cardiovascular events, and mortality. Early diagnosis and comprehensive assessment of ROD are crucial for enhancing the quality of life of CKD patients and reducing mortality rates. However, the diagnosis and evaluation of ROD remain significant challenges. Although tetracycline double-labeling of iliac crest biopsies is considered the gold standard for diagnosis, its invasiveness and limitations in dynamically monitoring continuous changes in bone morphology restrict its routine application. This article evaluates the research progress in noninvasive diagnostic techniques as alternatives to bone biopsy. These techniques encompass established and emerging bone biomarkers, traditional imaging modalities, and nuclear medicine approaches. The focus is on their application in assessing bone turnover and providing direction for future research. Some individual bone biomarkers and combinations of bone biomarkers have demonstrated considerable potential in the diagnosis of ROD. Quantitative analysis of ¹⁸F-NaF PET/CT has shown high sensitivity and specificity in diagnosing types of ROD and holds great promise for the evaluation of vascular calcification.