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Mineral and bone disorder in chronic kidney disease (CKD-MBD) is a triad of biochemical imbalances of calcium, phosphate, parathyroid hormone and vitamin D, bone abnormalities and soft tissue calcification. Maintaining optimal bone health in children with CKD is important to prevent long-term complications, such as fractures, to optimise growth and possibly also to prevent extra-osseous calcification, especially vascular calcification. In this review, we discuss normal bone mineralisation, the pathophysiology of dysregulated homeostasis leading to mineralisation defects in CKD and its clinical consequences. Bone mineralisation is best assessed on bone histology and histomorphometry, but given the rarity with which this is performed, we present an overview of the tools available to clinicians to assess bone mineral density, including serum biomarkers and imaging such as dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. We discuss key studies that have used these techniques, their advantages and disadvantages in childhood CKD and their relationship to biomarkers and bone histomorphometry. Finally, we present recommendations from relevant guidelines-Kidney Disease Improving Global Outcomes and the International Society of Clinical Densitometry-on the use of imaging, biomarkers and bone biopsy in assessing bone mineral density. Given low-level evidence from most paediatric studies, bone imaging and histology remain largely research tools, and current clinical management is guided by serum calcium, phosphate, PTH, vitamin D and alkaline phosphatase levels only., Author(s): A.D. Lalayiannis [sup.1] , N.J. Crabtree [sup.2] , M. Fewtrell [sup.1] , L. Biassoni [sup.1] , D.V. Milford [sup.2] , C.J. Ferro [sup.3] , R. Shroff [sup.1] Author Affiliations: [...]

Byline: N. J. Crabtree (1), H. Kroger (4), A. Martin (1), H. A. P. Pols (5), R. Lorenc (7), J. Nijs (8), J. J. Stepan (9), J. A. Falch (10), T. Miazgowski (11), S. Grazio (6), P. Raptou (12), J. Adams (13), A. Collings (1), K.-T. Khaw (3), N. Rushton (2), M. Lunt (1), A. K. Dixon (14), J. Reeve (1) Keywords: Key words:Bone biomechanics -- Bone densitometry -- DXA -- Hip fracture -- Hip strength analysis Abstract: Hip geometry and bone mineral density (BMD) have previously been shown to relate independently to hip fracture risk. Our objective was to determine by how much hip geometric data improved the identification of hip fracture. Lunar pencil beam scans of the proximal femur were obtained. Geometric and densitometric values from 800 female controls aged 60 years or more (from population samples which were participants in the European Prospective Osteoporosis Study, EPOS) were compared with data from 68 female hip fracture patients aged over 60 years who were scanned within 4 weeks of a contralateral hip fracture. We used Lunar DPX 'beta' versions of hip strength analysis (HSA) and hip axis length (HAL) applied to DPX(L) data. Compressive stress (Cstress), calculated by the HSA software to occur as a result of a typical fall on the greater trochanter, HAL, body mass index (BMI: weight/(height).sup.2) and age were considered alongside femoral neck BMD (FN-BMD, g/cm.sup.2) as potential predictors of fracture. Logistic regression was used to generate predictors of fracture initially from FN-BMD. Next age, Cstress (as the most discriminating HSA-derived parameter), HAL and BMI were added to the model as potentially independent predictors. It was not necessary to include both HAL and Cstress in the logistic models, so the entire data set was examined without excluding the subjects missing HAL measurements. Cstress combined with age and BMI provided significantly better prediction of fracture than FN-BMD used alone as is current practice, judged by comparing areas under receiver operating characteristic (ROC) curves (p&lt 0.001, deLong's test). At a specificity of 80%, sensitivity in identification was improved from 66% to 81%. Identifying women at high risk of hip fracture is thus likely to be substantially enhanced by combining bone density with age, simple anthropometry and data on the structural geometry of the hip. HSA might prove to be a valuable enhancement of DXA densitometry in clinical practice and its use could justify a more pro-active approach to identifying women at high risk of hip fracture in the community. Author Affiliation: (1) University Departments of Medicine, GB (2) Surgery, GB (3) Clinical Gerontology, GB (14) Radiology University of Cambridge, UK, GB (4) Department of Surgery, Kuopio University Hospital, Kuopio, Finland, FI (5) Department of Internal Medicine III, Erasmus University Medical School, Rotterdam, The Netherlands, NL (6) Department of Rheumatology, Clinical Hospital, Vinogradska, Zagreb, Croatia, YU (7) Department of Biochemistry &amp Experimental Medicine, Children's Health Centre, Warsaw, Poland, PL (8) Arthritis &amp Metabolic Bone Disease Research Unit, KV Leuven, Pellenberg, Belgium, BE (9) 3rd Department of Internal Medicine, Charles University Faculty of Medicine, Prague, Czech Republic, CZ (10) Department of Internal Medicine, Aker Hospital, Oslo, Norway, NO (11) Instytut Chorob Wewnetrznych, Pomorskiej Akademii Medycznej, Arkonska, Szczecin, Poland, PL (12) University of Athens, The Garafalidis Research Centre, Athens, Greece , GR (13) Clinical Radiology, Imaging Science and Biomedical Engineering, The University, Manchester, UK, GB Article note: Received: 16 March 2001 / Accepted: 3 August 2001

Background: Children with chronic liver disease are at risk of reduced bone mineral density (BMD), which may worsen in the months following liver transplantation (OLT). Probable aetiological factors include vitamin [...]