Is there a practical role for a virtual bone biopsy using high‐resolution imaging of bone in patients with chronic kidney disease?
The complex pathophysiology of ROD, combined with the limited efficacy of dual‐energy X‐ray absorptiometry (DXA) and the unreliability of currently used serum and urinary biomarkers to act as stand‐alone screening tools for fracture risk in patients with CKD, puts the onus of a definitive diagnosis on bone biopsy. However, this procedure is invasive, requires specialist expertise to perform and interpret the results and is rarely performed in current clinical practice. Moreover, bone histomorphometry only depicts microstructure at a single point in time and bone biopsies performed at one site may not reflect concurrent changes at another. The non‐invasive assessment of bone microstructure, by high‐resolution imaging techniques such as high‐resolution peripheral quantitative computed tomography (HR‐pQCT) and high‐resolution magnetic resonance imaging (HR‐MRI or micro‐MRI), has therefore attracted increased attention. To date, most research in high‐resolution imaging of bone has focused on populations without CKD; however, a few imaging studies have targeted the added complexities of bone pathology unique to the CKD population. We discuss the importance of these to the future diagnosis and management of ROD.