The healing effect of 1,25-dihydroxyvitamin D3 on periosteal and intracortical resorption and its failure to prevent progression of endosteal resorption in renal osteodystrophy

A Structural Approach to Renal Bone Disease

“…Because of this difference, the two surfaces can behave independently. For example, partial control of PTH hypersecretion by calcitriol therapy 58 or renal transplantation 59 may allow subperiosteal erosion to heal but cortical thinning to progress. Hand radiographs are uniquely suited to the study of renal bone disease, revealing not only subperiosteal and endocortical changes but metacarpal striation, indicating increased cortical porosity, a reflection of increased intracortical remodeling 53 .…”

“…Hand radiographs are uniquely suited to the study of renal bone disease, revealing not only subperiosteal and endocortical changes but metacarpal striation, indicating increased cortical porosity, a reflection of increased intracortical remodeling 53 . By the time dialysis is needed, many patients have changes on all three surfaces of cortical bone, 53 , 58 but the endocortical changes are the most consistent, representing the largest component of bone loss, and unlike the periosteal and intracortical changes, are irreversible 41 , 47 . Cortical thinning is much the largest component of the low values for radial single‐energy photon absorptiometry found at the onset of dialysis therapy, at both proximal and distal sites, 60–62 although the magnitude of the deficits is less if conservative management is improved and if dialysis is started earlier.…”

The influence of age and sex on bone resorption of secondary hyperparathyroidism in renal osteodystrophy

“…That such technique is absolutely essential for recognition of early changes of both subperiosteal and intracortical bone resorption has also been pointed out by Parfitt [9]. The usefulness of detecting and monitoring the course of renal osteodystrophy by this or similar methods is now well documented [9,10,[21][22][23]. Finally, the differences between our results and those of Moorhead et al [1] and Kanis [2] could also be partly explained by differences in treatment modalities: whereas patients of Moorhead et al [1] had all been hemodialyzed, and those of Kanis [2] were nondialyzed patients, our subject material consisted predominantly of peritoneally dialyzed patients.…”