The Localization of Aluminum in Bone: Implications for the Mechanism of Fixation and for the Pathogenesis of Aluminum-Related Bone Disease

Abstract

The clinical, biochemical, radiographic, histologic and prognostic features of aluminum-related bone disease, the sources and methods of removal of aluminum, the differences between epidemic and sporadic forms, and whether or not the condition should be referred to as aluminum-induced bone disease have all received a great deal of recent attention (1-8). Early reports identified three sites for aluminum deposition in bone -the junction between osteoid and mineralized bone, cement lines, and the neutral or quiescent bone surface (9-13). In the most comprehensive recent account the deposition of aluminum in bone is vaguely described as either on the bone surface or diffusely within the bone (7), but even in this era of molecular biology old fashioned anatomic precision should not be disdained. The purpose of this editorial review is to re-emphasize the importance of knowing exactly where aluminum is to be found in bone and the inferences that can be drawn from such knowledge.

Adynamic Bone Disease in Uremia: May It Be Idiopathic? Is It an Actual Disease?

“…Plasma calcium concentrations are at the upper limit of normal and increase rapidly above normal when oral calcium or calcitriol are given as for the pa tients with aluminic osteomalacia [8]. This phenomenon is probably explained by the deposition of aluminum at the quiescent bone surface which is the site of calcium exchange between blood and bone [1]. Plasma phosphate concentrations are also always increased so that the cal cium phosphate product is high and metastatic calcifica tions quite frequent [27].…”

“…Thus, according to Parfitt's conception of bone remodeling, adynamic bone disease uncompasses both the 'atypical osteomalacia' and the 'low turn over osteo penia' the latter entity differing from the former one only by a prevailing defect of bone formation over bone min eralization [1].…”

The spectrum of bone disease in 200 chronic hemodialysis patients: a correlation between clinical, biochemical and histological findings

“…Both clinical and experimental data indicate that aluminum impairs skeletal mineralization and diminishes bone cell activity. 23,24 Aluminum deposition in bones is often found within the mineralization front, which is located at the junction between osteoid seams and the mineralized bone. 3 At this site, calcification of newly formed bone collagen is initiated and aluminum has been shown to disrupt the mineralization process, slowing the rate of formation and growth of hydroxy apatite crystals.…”

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

“…In uremic patients, osteoidosis and adynamic (low turnover) bone disease are the two major types of aluminum-related osteopathy as evidenced by histological studies [10, 73, 80, 81, 82]. However, aluminum overload may simultaneously be found in the presence of osteitis fibrosa or a mixed type of renal osteodystrophy [83].…”