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

Abstract

Introduction:Renal osteodystrophy includes the complete range of mineral metabolism disorders that affect the skeleton in patients with chronic renal failure. Patients and Methods: 200 patients with end-stage renal disease and on dialysis were investigated regarding the clinical, biochemical and histological findings of bone disease. Results: The spectrum of renal osteodystrophy consisted mainly of high turnover bone lesions (74.5%), including osteitis fibrosa in 57.5%. Patients with mild bone disease were on dialysis for shorter periods of time and were mostly asymptomatic. Patients with aluminum-related bone disease (16.5%) had the greatest aluminum exposure, either orally or parenterally, and together with patients with high turnover mixed disease, were the most symptomatic. Although on a non-regular basis, the vast majority of the patients (82.5%) had been receiving vitamin D. The incidence of adynamic bone disease was high (n=8) among parathyroidectomized patients (n=12). Significantly higher serum levels of alkaline phosphatase were observed in osteitis fibrosa. Conclusions: The use of calcitriol and phosphate-binding agents on a non-regular basis seems to be the reason for the apparent reduced response to the treatment of secondary hyperparathyroidism. Alkaline phosphatase has been shown to be a fair marker for bone turnover in patients with osteitis fibrosa. The severity of the clinical manifestations of bone disease correlates with the histological features of bone lesion and to the time spent on dialysis.Uniterms: Renal osteodystrophy. Chronic renal failure. Hemodialysis. Aluminum intoxication. Bone metabolism.

Bone-specific alkaline phosphatase concentrations are less variable than those of parathyroid hormone in stable hemodialysis patients

“…One of the best known, and best established, of these is the plasma activity of ALP, which is increased in osteitis fibrosa. 28 High plasma ALP activity among hemodialysis patients is associated with increased risks of all-cause and cardiovascular mortality, 29, 30, 31 and it has been shown to be more sensitive to the effects of vitamin D replacement than PTH. 32, 33 However, the use of total ALP in this context has always been considered limited by its nonspecificity for bone disease, with only ∼50% of blood activity being attributable to bone ALP.…”

Circulating levels of osteoprotegerin and receptor activator of NF-κB ligand in patients with chronic renal failure

“…In pathological conditions, such as chronic renal failure (CRF), this process may be either accelerated or downregulated, and thus both high-and low-turnover renal osteopathies can be found (1). Renal osteodystrophy is a part of mineral bone disorders of chronic kidney disease and a multifactorial bone disorder (2). These include secondary hyperparathyroidism, vitamin D metabolic disorders, parathyroid hormone (PTH) resistance of bone cells, and immobility of patients, hypogonadism, amyloidosis or toxic osteodystrophy by aluminum, or poor dialysis quality (3).…”

99mTc-MDP bone uptake in secondary hyperparathyroidism: comparison of the mandible, cranium, radius, and femur

“…1,4,21 The hallmark of osteitis fi brosa is peritrabecular fi brosis associated with an elevated rate of bone remodeling in which reticular fi bers are replaced by collagen fi bers. 2,3 The main effect of PTHi on bone is an increase in the number of new basic multicellular units, which are the number of functional cells responsible for the calcium turnover of a remodeling unit.…”