Healthy bones

Tufts-NEMC establishes biopsy program

Bone health has become a major focus for health-care providers as the brittle bone disease osteoporosis threatens 44 million Americans, 68 percent of whom are women. Ten million Americans already have osteoporosis, and another 34 million have some degree of bone loss, placing them at risk for osteoporosis.

One in every two women and one in four men over age 50 will suffer an osteoporosis-related fracture in their lifetime.

Patients with chronic kidney disease are even more susceptible to bone disorders. And because bone biopsy remains the gold standard for diagnosing bone disease, Tufts-New England Medical Center’s William B. Schwartz Division of Nephrology has established a percutaneous Bone Biopsy Program.

Patients with chronic kidney disease (CKD) have a variety of bone problems, collectively known as renal osteodystrophy, a complex disorder that compromises bone strength and quality, according to Dr. Samina Khan, assistant professor of medicine at Tufts and director of the Bone Biopsy Program.

Overall bone health is defined by strength and quality, she notes. While bone strength can be determined through bone mineral density testing, bone quality—architecture, matrix composition and mineralization—can only be measured by examining the bone histology. Existing biochemical and imaging markers used for diagnosing renal osteodystrophy, osteoporosis and bone mineral density cannot accurately determine the type of bone disease among CKD patients, Khan says.

Bone disease occurs during the early stages of chronic kidney disease and worsens as the disease progresses. When CKD patients undergo a kidney transplant, Khan says almost all of them have some form of bone disease.

While bone biopsy is recommended for those with CKD, patients who’ve undergone other organ transplants and those with osteoporosis that is resistant to treatment also may benefit from the procedure, Khan says.

The biopsies are generally done on the hip bone. The Tufts-NEMC Bone Biopsy Program is the first in New England to perform the procedure with an electric drill rather than a needle—an approach that is safer and much more comfortable for patients, Khan says.