Table 3.
Possible indications for an iliac crest bone biopsy in renal osteodystrophya
| If a CKD patient with serum levels of intact PTH (iPTH) between 100 and 500 pg/mL (11.0–55.0 pmol/L) develops unexplained hypercalcaemia, bone pain or an increase in bone alkaline phosphatase activity | |
| Inconsistencies among biochemical parameters that do not allow a definitive interpretation of bone metabolism | |
| Unexplained skeletal fracture or bone pain | |
| In the absence of other known causes of a bone fracture (e.g. malignancy); in the case of low trauma, unexplained fracture | |
| Severe progressive vascular calcification | |
| Unexplained hypercalcaemia | |
| Suspicion of aluminium overload or toxicity (or possibly other metals like strontium), especially before chelation treatment due to possible side effects of DFO | |
| Before parathyroidectomy if there has been significant exposure to aluminium in the past or if the results of biochemical determinations are not consistent with advanced secondary or tertiary hyperparathyroidism | |
| Consider a biopsy before beginning treatment with bisphosphonates |
aModified after [1] and http://www.kidney.org/professionals/KDOQI/guidelines_bone/index.htm.