Hemodialysis bone disease: Correlation between clinical, histologic, and other findings

Abstract

This paper explores in patients with dialysis osteodystrophy the relationship between clinical features and histological, radiological, and biochemical findings. Eighty-five patients treated by hemodialysis for more than 6 months were studied. The following conclusions were drawn: 1) Bone pain in patients on regular hemodialysis is usually a symptom of developing osteomalacia but not of hyperparathyroidism or osteoporosis. 2) Many patients with histological osteomalacia and radiological features of osteomalacia, such as fractures or Looser zones, have no symptoms. 3)In dialysis patients, biochemical and radiological abnormalities are not a reliable means of predicting the presence of osteomalacia, but a raised serum alkaline phosphatase is a good indicator of the presence of osteitis fibrosa. For early detection of osteomalacia, bone biopsy in necessary. 4)A number of our dialysis patients develop an unusual form of osteomalacia characterized by absent or minimal histological osteitis fibrosa, a normal serum alkaline phosphatase, and a high incidence of myopathy and fractures.

Osteomalacia in Chronic Renal Failure: a Syndrome Previously Reported Only with Maintenance Dialysis

“…The present patient is unique because the development of this syndrome preceded the institution of dialysis. In all other respects, the clinical, biochemical and histologic features are similar to those previously reported [1][2][3]. The diagnosis of osteomalacia was made from the bone histology of two iliac crest bone biopsies performed 1 year apart.…”

“…All previous instances of this syndrome which includes osteomalacia, bone frac tures, PTH concentrations ranging from undetectable to minimal elevations, and a tendency to develop hypercal cemia with low dosages of any vitamin D analogs, have been reported only in maintenance dialysis patients [1][2][3]. The present patient is unique because the development of this syndrome preceded the institution of dialysis.…”

“…Bone biopsies have uniformly demonstrated severe osteomalacia without endosteal fi brosis [1,2]. When measured, the immunoreactive para thyroid hormone (PTH) concentration has ranged from undetectable to minimal elevations.…”

“…When measured, the immunoreactive para thyroid hormone (PTH) concentration has ranged from undetectable to minimal elevations. These patients gen erally present with a normal or minimally elevated serum calcium, and if treatment is instituted with vitamin D or its metabolites, hypercalcemia frequently ensues despite careful titration of the dosage [1][2][3]. Other reported bio chemical features have included normal or only minimal elevation of serum alkaline phosphatase [1,4] and nor mal levels of 25-hydroxycholecalciferol (25(OH)D3).…”

Renal Osteodystrophy: New Insights in Pathophysiology and Treatment Modalities with Special Emphasis on the Insulin-Like Growth Factor System

“…Additionally, aluminum suppresses PTH secretion [87] and can also induce resistance to PTH and vitamin D [88]. Hypoparathyroidism and other states of reduced bone turnover accelerate the accumulation of aluminum [11, 89, 90, 91]. Thus, diabetes mellitus may be an additional predisposing factor [8, 92].…”