Hypokinetic azotemic osteodystrophy

Abstract

This man had long-standing, slowly progressive renal failure. When he entered the dialysis program, his renal osteodystrophy was symptomatic. Most of his signs and symptoms were interpreted as due to secondary hyperparathyroidism (osteitis fibrosa), even

Adynamic bone disease: clinical and therapeutic implications

“…The rate of collagen synthesis by osteoblasts and the subsequent mineralization of bone are subnormal. This latter finding distinguishes adynamic bone from the other low-turnover bone form -osteomalacia, in which the mineralization defect exceeds the defect on bone formation resulting in an excess of osteoid [7, 8,9 ]. In adynamic bone, the number of osteoblasts is reduced, and minimal or no peritrabecular fibrosis or marrow fibrosis is present.…”

“…It markedly reduces parathyroid hormone (PTH) synthesis and release even in the presence of hyperphosphatemia. A chronic low-dose exposure to aluminum in combination with high dosages of vitamin D may preferentially lead to adynamic bone disease rather than osteomalacia [8]. For example, in a recent bone biopsy trial from Brazil [12 ], a high proportion of patients with adynamic bone presented positive aluminum staining.…”

“…Proximal muscle weakness, axial skeletal pain and bone fractures of the ribs, vertebral bodies, pelvis and hips have been described traditionally in association with aluminum-induced low-turnover bone [8,10]. More recently, it became evident that any type of adynamic bone may cause bone pain and carries a significant morbidity and mortality [22].…”

Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management

“…The novel noncalcium based phosphate binders such as sevelamer and lanthanum carbonate may be superior to the calcium based binders as they are associated with less progression of vascular calcification and hypercalcaemia [29,30], although the evidence for patient relevant cardiovascular or bone outcomes is limited [29,30]. Aluminium based phosphate binders are potent phosphate binders but are not suitable for long-term use because of the risk of adynamic bone disease and aluminium toxicity [8,31,32].…”

Patologiya kostnoy sistemy pri vtorichnomgiperparatireoze u patsientov s terminal'noystadiey khronicheskoy bolezni pochek na zamestitel'noypochechnoy terapii (gemodializ) (obzor literatury)

“…остеомаляция возникает в результате снижения ремоде-лирования, скорости образования нормальной костной ткани, возникновения дефектов минерализации [19], приводя к фор-мированию неминерализованного остеоида. В норме остеобла-сты продуцируют в день слой остеоида толщиной 1 мкм, кото-рый спустя 10 дней подвергается минерализации.…”