肾性骨营养不良(renal osteodystrophy，ROD)指慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder，CKD-MBD)的骨改变。尽管四环素标记的经髂骨活检是ROD诊断和分型的金标准，但受有创性、患者意愿和专家等的限制，在临床上几乎不开展。本文综述了近年来ROD的诊断新进展，包括骨活检的改良，无创成像技术的兴起，新型骨转换标志物(bone turnover marker，BTM)的出现及相互间的组合应用，使得无创精准的“虚拟骨活检”成为可能。

Renal osteodystrophy (ROD) refers to the skeletal alterations of chronic kidney disease-mineral and bone disorder (CKD-MBD) in patients with chronic kidney disease (CKD). Tetracycline-labeled bone biopsy is a golden standard for the diagnosis and classification of ROD. However, bone biopsy is often rejected by the patients and professionals due to the invasive operation. This review focuses on recent advances in the diagnosis of ROD, including modified bone biopsy, non-invasive imaging techniques, and novel bone turnover markers, enabling to develop a non-invasive and accurate virtual bone biopsy that improves diagnostic performance.