Aluminum toxicity to bone: A multisystem effect?

Abstract

Aluminum (Al) is the third most abundant element in the earth's crust and is omnipresent in our environment, including our food. However, with normal renal function, oral and enteral ingestion of substances contaminated with Al, such as antacids and infant formulae, do not cause problems. The intestine, skin, and respiratory tract are barriers to Al entry into the blood. However, contamination of fluids given parenterally, such as parenteral nutrition solutions, or hemodialysis, peritoneal dialysis or even oral Al-containing substances to patients with impaired renal function could result in accumulation in bone, parathyroids, liver, spleen, and kidney. The toxic effects of Al to the skeleton include fractures accompanying a painful osteomalacia, hypoparathyroidism, microcytic anemia, cholestatic hepatotoxicity, and suppression of the renal enzyme 25-hydroxyvitamin D-1 alpha hydroxylase. The sources of Al include contamination of calcium and phosphate salts, albumin and heparin. Contamination occurs either from inability to remove the naturally accumulating Al or from leeching from glass columns used in compound purification processes. Awareness of this long-standing problem should allow physicians to choose pharmaceutical products with lower quantities of Al listed on the label as long as this practice is mandated by specific national drug regulatory agencies.

Titanium Alloys for Dental Implants: A Review

“…However, this alloy releases both aluminium and vanadium [7], both of which are capable of causing biological problems. Aluminium interferes with bone mineralization [8], leading to structural deficiencies, and vanadium is both cytotoxic and capable of causing type IV (allergic) reactions [9]. To have these adverse effects, they both need to be present in the tissues at reasonable concentrations, and levels released from this alloy are well below those needed to produce toxic effects [7].…”

Aluminium toxicosis: a review of toxic actions and effects

“…In individuals where neurodegerative conditions affect the nerve supply to muscles, the muscles may undergo denervation atrophy and become dysfunctional as in multiple sclerosis or amyotropic lateral sclerosis. Taken together, Al toxicosis may cause muscle damage, inflammation and dysfunction The bone diseases associated with Al exposure are osteoporosis, osteomalcia, rickets, exostosis, osteodystrophy and osteitis fibrosa (Sherrard et al, 1985;Chappard et al, 2016;Rodríguez and Mandalunis, 2018;Klein, 2019). There is increased risk of osteoporosis and low bone mineral density during Al exposure (Cao et al, 2016; because of disruption of bone formation, and inhibition of osteoblast proliferation, differentiation and mineralization (Li et al, 2012(Li et al, , 2016Cao et al, 2016;Yang et al, 2016;Zhu et al, 2016b;Song et al, 2017;Sun et al, 2017;Huang et al, 2017).…”

“…Toxicosis due to Al accumulation in mammalian tissues was associated with various pathologic effects (Wills and Savory, 1983;Kaiser et al, 1984;Boyce et al, 1986;Drüeke et al, 1986;Hewitt et al, 1990;Bushinsky et al, 1995;Reinke et al, 2003;Abubakar et al, 2004;Bogdanović et al, 2008;Yousef and Salama, 2009;Khattab et al, 2010;Blaylock, 2012;Buraimoh and Ojo, 2013;Sumathi et al, 2013). Recent reviews on toxic effects of Al covered reproductive toxicity (Mouro et al, 2017), pulmonary lesions (Kongerud and Søyseth, 2014;Taiwo, 2014), impact on the breast (Darbre, 2016), bone abnormalities (Chappard et al, 2016;Klein, 2019), immunotoxity (Zhu et al, 2014a) and neurologic disorders (Colomina and Peris-Sampedro, 2017;Morris et al, 2017). This review is an abridged and global overview of toxic effects of Al and its compounds, covering some relevant aspects of exposure and updated systemic toxicosis in humans and animals, relevant as background for prospective toxicopathologic studies.…”

Aggregated aluminium exposure: risk assessment for the general population

“…anxiety or libido), as well as visual changes such as hair loss or piloerection (EFSA 2008;JECFA 2012;SCCS 2014). Toxicity to bone was reported in humans and animals (Klein 2019;Rodriguez and Mandalunis 2018).…”