How do you approach the diagnostic evaluation of osteoporosis in CKD when renal dysfunction limits use of certain tests or biomarkers?

DEXA is still appropriate, and if anything, would underestimate the actual bone loss. For serum biomarkers, only TRAP5B, bone-specific Alkaline phosphatase (BSAP), and PINP are not altered with renal impairment (i.e., not partially cleared by the kidneys, leading to circulating fragments that render...