Histomorphometric measurements of bone turnover, mineralization, and volume. 2008

Susan M Ott
Department of Medicine, University of Washington, Seattle, WA 98195-6426, USA. smott@u.washington.edu

A recent Kidney Disease: Improving Global Outcomes report suggested that bone biopsies in patients with chronic kidney disease should be characterized by determining bone turnover, mineralization, and volume. This article focuses on the calculations and interpretation of these measurements. In most cases of renal osteodystrophy, the bone formation rate is roughly similar to the bone resorption rate; therefore, the bone formation indices can be used to describe turnover. It is important to remember that these conventions will not apply in some situations. Activation frequency should not be confused with bone formation rate or bone metabolic unit birth rate. Abnormal mineralization can be described using the osteoid volume, increased osteoid maturation time, or increased mineralization lag time. The concept of bone volume is the easiest to understand, but there is a large error from one biopsy to the next in the same person. There are some difficulties with each of the measurements, and further research in patients with chronic kidney must be done to enable a consensus to be reached about cut points to define categories within the spectrum of renal osteodystrophy and how to evaluate treatment responses.

UI MeSH Term Description Entries
D007674 Kidney Diseases Pathological processes of the KIDNEY or its component tissues. Disease, Kidney,Diseases, Kidney,Kidney Disease
D010012 Osteogenesis The process of bone formation. Histogenesis of bone including ossification. Bone Formation,Ossification, Physiologic,Endochondral Ossification,Ossification,Ossification, Physiological,Osteoclastogenesis,Physiologic Ossification,Endochondral Ossifications,Ossification, Endochondral,Ossifications,Ossifications, Endochondral,Osteoclastogeneses,Physiological Ossification
D012080 Chronic Kidney Disease-Mineral and Bone Disorder Decalcification of bone or abnormal bone development due to chronic KIDNEY DISEASES, in which 1,25-DIHYDROXYVITAMIN D3 synthesis by the kidneys is impaired, leading to reduced negative feedback on PARATHYROID HORMONE. The resulting SECONDARY HYPERPARATHYROIDISM eventually leads to bone disorders. Renal Osteodystrophy,Renal Rickets,Rickets, Renal,CKD-MBD,Osteodystrophy, Renal,Chronic Kidney Disease Mineral and Bone Disorder,Osteodystrophies, Renal,Renal Osteodystrophies
D001842 Bone and Bones A specialized CONNECTIVE TISSUE that is the main constituent of the SKELETON. The principal cellular component of bone is comprised of OSTEOBLASTS; OSTEOCYTES; and OSTEOCLASTS, while FIBRILLAR COLLAGENS and hydroxyapatite crystals form the BONE MATRIX. Bone Tissue,Bone and Bone,Bone,Bones,Bones and Bone,Bones and Bone Tissue,Bony Apophyses,Bony Apophysis,Condyle,Apophyses, Bony,Apophysis, Bony,Bone Tissues,Condyles,Tissue, Bone,Tissues, Bone
D001862 Bone Resorption Bone loss due to osteoclastic activity. Bone Loss, Osteoclastic,Osteoclastic Bone Loss,Bone Losses, Osteoclastic,Bone Resorptions,Loss, Osteoclastic Bone,Losses, Osteoclastic Bone,Osteoclastic Bone Losses,Resorption, Bone,Resorptions, Bone
D002113 Calcification, Physiologic Process by which organic tissue becomes hardened by the physiologic deposit of calcium salts. Bone Mineralization,Calcification, Physiological,Physiologic Calcification,Mineralization, Bone,Physiological Calcification
D002908 Chronic Disease Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care (Dictionary of Health Services Management, 2d ed). For epidemiological studies chronic disease often includes HEART DISEASES; STROKE; CANCER; and diabetes (DIABETES MELLITUS, TYPE 2). Chronic Condition,Chronic Illness,Chronically Ill,Chronic Conditions,Chronic Diseases,Chronic Illnesses,Condition, Chronic,Disease, Chronic,Illness, Chronic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001706 Biopsy Removal and pathologic examination of specimens from the living body. Biopsies
D016723 Bone Remodeling The continuous turnover of BONE MATRIX and mineral that involves first an increase in BONE RESORPTION (osteoclastic activity) and later, reactive BONE FORMATION (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium HOMEOSTASIS. An imbalance in the regulation of bone remodeling's two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as OSTEOPOROSIS. Bone Turnover,Bone Turnovers,Remodeling, Bone,Turnover, Bone,Turnovers, Bone

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