AI Article Synopsis

  • Bone biopsy (BB) with histomorphometric analysis is the gold standard for diagnosing and classifying renal osteodystrophy, offering detailed insights into various bone parameters that other methods can't accurately capture.
  • Despite its importance in managing chronic kidney disease (CKD) patients, the number of bone biopsies performed has declined due to factors like the perceived invasiveness of the procedure, pain, and issues with reimbursement.
  • A multidisciplinary Italian position paper emphasizes the need to reintegrate bone biopsies into CKD management by standardizing procedures, creating support networks, and advocating for better reimbursement policies.

Article Abstract

Bone Biopsy (BB) with histomorphometric analysis still represents the gold standard for the diagnosis and classification of different forms of renal osteodystrophy. Bone biopsy is the only technique able to provide comprehensive information on all bone parameters, measuring static and dynamic parameters of turnover, cortical and trabecular microarchitecture, and mineralization defects. In nephrological practice, bone biopsy yields relevant indications to support therapeutic choices in CKD, heavily impacting the management and prognosis of uremic patients. Unfortunately, the use of bone biopsy has decreased; a lack of expertise in performing and interpreting, perceived procedure invasiveness and pain, and reimbursement issues have all contributed to this decline. Nevertheless, both bone biomarkers and instrumental images cannot be considered reliable surrogates for histological findings, being insufficiently accurate to properly evaluate underlying mineral and bone disorders. This is a multidisciplinary position paper from the Nephrology and Osteoporosis Italian Scientific Societies with the purpose of restating the role of bone biopsy in CKD patient management and of providing strong solutions to allow diffusion of this technique in Italy, but potentially also in other countries. The Italian approach through the optimization and standardization of bone biopsy procedure, the construction of the Italian Hub and Spoke network, and a request for adjustment and national homogenization of reimbursement to the Italian Health Ministry has led the way to implement bone biopsy and to improve CKD patient management and prognosis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103887PMC
http://dx.doi.org/10.3390/nu14091742DOI Listing

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