Table 1.

Summary of studies comparing parathyroid hormone levels with bone biopsy data. Some notable studies that have correlated parathyroid hormone (PTH) with bone biopsy findings (Pubmed search strategy: All English language papers). PD, peritoneal Dialysis; HD, haemodialysis; Ca, calcium; ALP, Alkaline Phosphatase

Authors, year	Population (n)	Age of population (years)	Key findings on bone biopsies	Correlations with PTH	Limitations	Comments
Salusky et al., 1988 [117]	PD (44)	6–18	Normal histology in 16% Osteitis fibrosa in 39% Aplastic lesions in 11% Osteomalacia in 9%	Bone formation rate and larger resorption areas correlated with PTH (p < 0.001) PTH values were 2–3× higher in osteitis fibrosa patients	Study prior to TMV criteria Aluminium hydroxide main phosphate binder	Focus of study primarily on aluminium staining—as aluminium hydroxide used as main type of phosphate binder.
Mathias et al., 1993 [118]	HD (21)	16–19	High-turnover disease in 38% Osteitis fibrosa in 23% Adynamic bone in 28%	Bone formation rate correlated with PTH as well as resorption areas (p < 0.001).	Study prior to TMV criteria Aluminium hydroxide main phosphate binder	PTH also correlated inversely with serum Ca levels (p < 0.001)
Goodman et al., 1994 [119]	PD (14)	13–14	Before calcitriol: osteitis fibrosa in 79% After calcitriol: normal in 43% Adynamic in 43% Osteitis fibrosa in 7% Mixed in 7%	A PTH of below 200 pg/mL was strongly suggestive of adynamic bone disease.	Small number of patients	Aim of study was to look at effect of intermittent calcitriol therapy over 12 months on bone biopsy indices.
Salusky et al., 1994 [65]	PD (55) (68 bone biopsies)	8–19	Osteitis fibrosa in 50% Mild hyperparathyroidism in 9% Adynamic bone lesions in 22% Normal in 19%	High PTH values strongly correlated with osteitis fibrosa lesions vs mild, adynamic or normal histology (p < 0.001)		PTH > 200 pg/mL and Ca < 10 mg/dl was 85% sensitive and 100% specific for high-turnover lesions. PTH < 200 pg/mL 100% sensitive, 79% specific for adynamic bone lesions
Yalçinkaya et al., 2000 [120]	PD (17)	7–20	High-turnover disease in 47% Low turnover disease in 29% Mixed in 24%	High PTH values were significantly correlated to high-turnover disease (p < 0.01) vs low turnover	Small number of patients	Mean serum Ca levels higher in low-turnover group vs high-turnover group (p < 0.001) Serum PTH > 200 pg/mL was 100% sensitive and 66% specific in identifying high turnover.
Ziólkowska et al., 2000 [121]	HD (21), PD (30)	7–15	Adynamic bone disease in 27% Normal bone in 37% Osteomalacia in 2% Hyperparathyroidism in 24% Mixed lesions in 10%	Higher PTH significantly correlated with high-turnover disease vs adynamic or normal bone.		Serum PTH > 200 pg/mL: 75% sensitive and 95% specific for identifying high-turnover disease In patients with normal bone turnover, 69% had PTH level of 50–150 pg/mL
Waller et al., 2008 [66]	Pre-Tx (11)	7–16	Low bone turnover disease in 18% Mixed lesions in 27% Hyperparathyroidism in 36%	PTH > 3× ULN associated with high turnover Normal range PTH associated with low turnover	Small number of patients
Bakkaloglu et al., 2010 [62]	PD (161)	0–20	Low turnover in 4% Normal turnover in 39% High turnover in 57% Abnormal mineralisation in 48%	Higher PTH significantly correlated with high-turnover disease vs low turnover or normal bone.		For any level of turnover, PTH was higher if mineralisation defects were present (p < 0.01). PTH < 400 pg/mL and ALP < 400 IU/L provided the highest prediction of normal bone turnover and mineralisation
Wesseling-Perry et al., 2012 [63]	CKD2-5 (52)	2–21	High bone turnover in: 13% with CKD3 29% with CKD 4/5 Defective mineralisation in: 29% with CKD2 42% with CKD3 79% with CKD4/5	PTH was elevated in 36% of patients with CKD2, 71% with CKD3, and 93% with CKD4/5		PTH was directly linked to poor mineralisation (p < 0.05)
Carvalho et al., 2015 [122]	PD (22)	2–16	High bone turnover in 54% Low bone turnover in 23% Normal turnover in 23%	PTH values higher in patients with high bone turnover (p < 0.05) and mineralisation (p < 0.01)	Small number of patients	Bone turnover correlated with alkaline phosphatase also (p < 0.01)