Bone biopsy in chronic kidney disease: still neglected and in need of revitalization

Renal osteodystrophy (ROD) is now included in the larger chronic kidney disease–mineral bone disorder (CKD-MBD) with evidence of a specific contribution to increased mortality in renal diseases. Bone biopsy is universally recognized as the gold standard diagnostic test for ROD, but due to limited diffusion, Kidney Disease: Improving Global Outcome (KDIGO) guidelines do not recommend it widely. The now better-appreciated endocrine role of bone and the intriguing relationship between osteoporosis and ROD in chronic renal failure warrants a definite appreciation of the pathomechanisms involved in these diseases to decide the best therapy. In particular, antiresorptive therapies now available for osteoporosis should be better evaluated in renal patients with bone biopsies. For this reason, the paper by Novel-Catin et al. [1] suggesting the use of a small needle to perform bone biopsies deserves attention, because it could enable the increased use of bone biopsies in CKD.