Bone histomorphometry for the diagnosis of renal osteodystrophy: a call for harmonization of reference ranges

A bone biopsy of the anterior iliac crest is the gold standard for the evaluation of bone disease in chronic kidney disease. The bone histomorphometric analysis consists of a detailed description of bone histology, including skeletal remodeling, bone mineralization, and bone microarchitecture. Like many histopathologic diagnostic classifications (e.g., Banff), bone histomorphometry is based on a semiquantitative assessment, utilizing both quantitative cutoffs of key parameters and a qualitative interpretation by an experienced physician.