Renal bone disease: Radiological investigation

The bone disease associated with chronic renal impairment is complex and mu ltifactorial, and has changed over past decades. Whereas originally feature s of vitamin D deficiency (rickets/osteomalacia) and secondary hyperparathr oidism (erosions, osteosclerosis, brown cysts) predominated, improvement in management and therapy have resulted in such readiographic features being present in a minority of patients. Metastatic calcification and "adynamic" bone develop as a complication of disease (phosphate retention) and treatme nt (phosphate binders). New complications (amyloid deposition, noninfective spondyloarthropathy, osteonecrosis) are now seen complicating long-term he modialysis and/or renal transplantation. Radiographs remain the most import ant imaging technique, but occasionally other imaging and quantitative tech niques (CT, MRI, bone densitometry) are relevant to diagnosis and managemen t.