Skeletal X-ray findings and bone histology in patients on hemodialysis

Abstract

X-ray films of the hand skeleton (mammography technique), serum chemistry, and quantitative bone histology (micromorphometry of undecalcified sections, iliac crest spongiosa) were compared in 25 patients on maintenance hemodialysis. The X-ray findings correlated better with serum PTH levels than with bone histology. Of all radiological signs of renal osteodystrophy, pronounced subperiosteal resorption (radial aspect, second finger, middle phalanx) and periosteal new bone formation (middle phalanx) correlated best with histological indicators of osteitis fibrosa. These signs were never seen in control patients. Acroosteolysis (endphalanx) and intracortical or endosteal resorption (middle phalanx) were less specific (i.e., seen even in the absence of metabolic bone disease) and correlated less with bone histology. Osteosclerosis in iliac cancellous bone was paralleled by abnormal texture of spongy bone in the proximal metaphysis of the middle phalanx (second finger).

Lack of Relation between Secondary Hyperparathyroidism and Red Blood Cell Osmotic Fragility in Chronic Renal Failure

“…But, the specific PTH assay used has been previously shown to correlate well with the histomorphometric features of osteitis fibrosa in uremic patients [22], Moreover, RBC osmotic fragility also failed to correlate with serum alkaline phosphatase levels, which are a reliable hematochemical index of the activity of secondary HPT [23]. Second, no difference in RBC osmotic fragility was found with regard to the severity of secondary HPT as evaluated on the basis of radiographic findings [24]. Lastly, effective treatment of secondary HPT by either pharmacological means [10] or surgical removal was not associated with consequent improvement in RBC osmotic fragility, as would be ex pected if it was impaired by PTH.…”

Effect of Chronic Propranolol Treatment on Bone Changes of Secondary Hyperparathyroidism in Dialysis Patients

“…In patients of group A propranolol compliance was assessed during the first two treatment years by measuring the blood drug levels [5], thereafter by monitoring blood pressure and pulse rate. score modified, graded 0-10) [6] was almost the same in the two groups (7 ± 3 vs. 7 ± 3); serum-COOH terminal i-PTH fragment (24.8rt 10.8 vs. 22.1 ± 3 .7 mU/ml) and ionised calcium (1.70±0.08 vs. 1.75 ±0.12 mA//I) were also similar. As far as can be judged from a retrospective study, the data show that chronic propranolol treatment does not to any appreciable extent prevent bone changes of uremic secondary hyperparathyroidism.…”

Roentgenographic Manifestations of Maxillomandibular Renal Osteodystrophy

“…However, the abnormalities in the jaw, with 14 of 30 patients showing periosteal ero sions, were more obvious than those in the hand, suggest ing that the jaw is a more sensitive indicator than Meema et al [19][20][21] and Ritzel al. [22] have found. We did not use magnification radiography [23,24], Therefore, 26 of 30 patients (87%) showed roentgenographic evidence of bone disease.…”