Get-up and Go: Adynamic Bone Disease in Chronic Kidney Disease Patient

Abstract

We reported a case of adynamic bone disease (ABD) in an older woman with chronic kidney disease, stage-4 (CKD-4), with an estimate of 29ml/min glomerular filtration rate (eGFR). Similarly, the patient presented with bone pain and osteoporosis as well as intact parathyroid hormone (PTH) was suppressed (<6ng/dl) secondary to the use of vitamin D analogs for secondary hyperparathyroidism (SHPT) of CKD. Furthermore, the hypercalcemia of (11.1 mg/dl), and her dual-energy X-ray absorptiometry (DEXA) scan showed bone mineral density (BMD) of -2.6 SD. Low levels of PTH induces a state of low turnover bone disease. Numerous, factors are involved in this process in patients with ESRD on dialysis. Among these factors are the use of vitamin D analogs, the ill-effects high calcium baths, treatment of osteoporosis with bisphosphonates, etc. All these factors can singly or in combination suppress PTH and render the bone resistant to its action with the end results of a dynamic bone disease. The vitamin D analogs were stopped to allow recovery of the PTH and activation of the osteocytes and osteoblasts. Six months after stopping active vitamin D analogs, her hypercalcemia was resolved, and the PTH increased to 172 ng/dl. Her bone pain has resolved.