Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia.
Nephrology (Carlton). 2016 Oct;21(10):801-11. doi: 10.1111/nep.12790.
The term renal osteodystrophy refers to changes in bone morphology induced by chronic kidney disease (CKD) and represents the skeletal component of the entity 'chronic kidney disease - mineral and bone disorder'. Changes in turnover, mineralization, mass and microarchitecture impair bone quality, compromising strength and increasing susceptibility to fractures. Fractures are more common in CKD compared with the general population and result in increased morbidity and mortality. Screening for fracture risk and management of renal osteodystrophy are hindered by the complex, and still only partially understood, pathophysiology and the inadequacy of currently available diagnostic methods. Bone densitometry and bone turnover markers, although potentially helpful, have significant limitations in patients with CKD, and the 'gold standard' test of bone biopsy is infrequently performed in routine clinical practice. However, recent advances in high-resolution bone microarchitecture imaging may offer greater potential for quantification and assessment of bone structure and strength and, when used in conjunction with serum biomarkers, may allow non-invasive testing for a diagnostic virtual bone biopsy.
肾性骨营养不良是指由慢性肾脏病（CKD）引起的骨骼形态变化，是“慢性肾脏病-矿物质和骨异常”这一实体的骨骼组成部分。骨转换、矿化、质量和微结构的变化会损害骨质量，使骨骼强度降低，增加骨折易感性。与普通人群相比，CKD 患者更容易发生骨折，这导致发病率和死亡率增加。骨折风险的筛查和肾性骨营养不良的管理受到复杂且仍不完全了解的病理生理学和现有诊断方法不足的阻碍。骨密度测定和骨转换标志物虽然有一定帮助，但在 CKD 患者中存在显著局限性，而骨骼活检这一“金标准”检测在常规临床实践中很少进行。然而，最近在高分辨率骨微结构成像方面的进展可能为骨结构和强度的定量和评估提供更大的潜力，并且当与血清生物标志物结合使用时，可能允许进行非侵入性的虚拟骨活检诊断测试。
