Chronic kidney disease (CKD) affects over 10% of the global population and often leads to skeletal complications collectively termed renal osteodystrophy (ROD). Accurate monitoring of bone turnover is critical, as patients may experience abnormally high or low turnover – each requiring different treatments. Yet, the gold-standard diagnostic method, bone biopsy, is invasive and rarely used in routine care.
In their recent study published in the Journal of Bone and Mineral Research, Zhou et al. present a novel application of time-lapse high-resolution peripheral quantitative computed tomography (TL HR-pQCT) as a non-invasive imaging method for CKD patients. This approach tracks changes in bone microarchitecture over time, enabling direct, in vivo assessment of local bone turnover – essentially functioning as a repeated “virtual biopsy” of the same bone volume.
The pilot study followed patients with end-stage kidney disease on dialysis, using scans at the distal radius and tibia. Remarkably, even over just two months, TL HR-pQCT detected significant and reproducible changes in bone formation and resorption. The technique captured particularly high turnover in trabecular bone at the radius, and notable cortical bone loss – hallmark features of ROD.
These results suggest TL HR-pQCT can sensitively and reliably monitor short-term skeletal changes in CKD, outperforming traditional tools like DXA and biochemical markers, which lack precision or are confounded by impaired kidney function.
In an accompanying editorial, Dr. Dr. Felix von Brackel highlights TL HR-pQCT as a promising step toward reducing reliance on invasive biopsies. The commentary notes important challenges such as motion artifacts and the need for further validation against histomorphometry but stresses the technology’s potential to transform CKD bone care by enabling repeated, site-specific assessments over time.
Though not yet ready for routine clinical use, TL HR-pQCT could usher in a new era of personalized skeletal monitoring for CKD. By providing a detailed, non-invasive window into local bone remodelling, it holds promise for a more accurate diagnosis and better and more targeted treatment decisions.