Renal Osteodystrophy: Multimodality Imaging

Abstract Purpose of Review Chronic Kidney disease (CKD) is a global health concern, affecting over 10% of the population and associated with significant morbidity and mortality, particularly due to cardiovascular complications. CKD is defined by structural or functional kidney abnormalities persisting for over three months, with diagnosis based on reduced glomerular filtration rate (GFR < 60 mL/min/1.73 m²) or markers of renal damage, such as albuminuria (> 30 mg/g creatinine). A critical complication of CKD is mineral and bone disorder, including renal osteodystrophy, which presents diagnostic challenges due to its complex pathophysiology. This review critically evaluates the role of established and emerging imaging modalities in diagnosing renal osteodystrophy, a complex and critical mineral and bone disorder complicating CKD. It aims to guide clinicians in selecting optimal diagnostic strategies by synthesizing current evidence. Recent Findings Conventional diagnostic methods, particularly dual-energy X-ray absorptiometry, are frequently limited in their accuracy due to the confounding effects of vascular calcification and aberrant bone turnover. Recent advancements highlight the potential of radiation-free methods, such as Radiofrequency Echographic Multi-Spectrometry (REMS), to overcome these limitations. Furthermore, advanced imaging techniques including high-resolution peripheral quantitative computed tomography (HR-pQCT) and trabecular bone score (TBS) show significant promise for providing a more comprehensive assessment of bone microarchitecture and strength. Summary The emergence of innovative imaging tools offers the potential to improve the early detection and monitoring of renal osteodystrophy. By moving beyond the limitations of traditional bone density measurement, these technologies may lead to more accurate diagnosis and better management, ultimately enhancing patient outcomes.