A need for normalization of bone histomorphometry parameters in chronic kidney disease

Area of Science:

• Nephrology
• Pathology
• Bone Biology

Background:

• Bone histomorphometry offers direct tissue-level assessment of bone remodeling, mineralization, and volume in chronic kidney disease (CKD).
• The turnover, mineralization, volume (TMV) classification provides a unified framework for renal osteodystrophy but faces inconsistent application.
• Lack of standardized normative reference values hinders the clinical and research utility of the TMV system.

Purpose of the Study:

• To highlight the need for standardized normative reference values in bone histomorphometry for CKD.
• To address the inconsistencies in the application of the TMV classification for renal osteodystrophy.
• To emphasize the importance of both trabecular and cortical bone compartments in histomorphometric analysis.

Main Methods:

• Review of recent consensus statements and analytical studies on TMV classification variability.
• Analysis of emerging strategies for generating normative datasets, including bone biopsies from living kidney donors.
• Examination of the underrepresentation and methodological inconsistencies in cortical bone histomorphometry.

Main Results:

• Significant inter-center variability exists in TMV classification use due to differing reference standards and reporting practices.
• Proposed strategies for generating contemporary normative datasets are ethically acceptable.
• Cortical bone histomorphometry is increasingly recognized but lacks standardization.

Conclusions:

• Normalization of histomorphometric parameters for both trabecular and cortical bone is the primary challenge.
• Standardization is essential to improve the clinical and scientific impact of bone histomorphometry in CKD.
• Integration with biomarkers, imaging, and data-driven approaches is key for advancing bone assessment in CKD.