When should bone biopsy be considered to guide management in patients in whom you're differentiating osteoporosis and renal osteodystrophy?

This is a major issue in patients with advanced CKD. Definitive RCT treatment trials for osteoporosis had an inclusion criteria of a normal PTH and an exclusion criteria of elevated creatinine greater than 1.1 to 1.5 (depending on the study). Therefore, in patients with CKD 3 and more severe CKD, AN...