Histological, Radiological, and Biochemical Features of the Adynamic Bone Lesion in Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Adynamic bone is being found with increasing frequency in dialysis patients. Little is known about its aetiology, and even less about its natural history. We found 10 cases of asymptomatic adynamic bone among a group of 32 continuous ambulatory peritoneal dialysis patients, most of whom had never been exposed to aluminium-containing phosphate binders. Compared to the remaining 22 patients, they had an older mean age (54 ± 11.4 vs. 42 ± 11.8 years; p < 0.05), probably a longer pre-dialysis duration of renal failure (10.9 vs. 7.1 years), higher mean ionized calcium (1.30 ± 0.04 vs. 1.15 ± 0.02 mmol/l; p < 0.01), and lower mean intact parathyroid hormone (31.5 vs. 200.3 pg/ml; p < 0.001). The bone density was not different between the two groups, but 9 of the 10 adynamic patients had significant vascular calcification seen on plain radiology as compared with only 7 of 20 in the comparison group (p < 0.05). Follow-up of the adynamic patients showed a close association with serum intact parathyroid hormone and ionized calcium levels. With one exception, adynamic bone did not appear to be associated with lower bone density than other types of osteodystrophy, but a longer-term study is required to determine the complete natural history of this lesion.

Causes and Consequences of Adynamic Bone Disease

“…In common with aluminum-related ABD, non-aluminum ABD is characterized by a tendency to hypercalcemia and metastatic calcification [12, 13], and there is therefore a potential risk of calciphylaxis and arteriosclerosis. By definition, the ability of bone to buffer a calcium load should be reduced in ABD, and this is indeed found to be the case [14].…”

“…In theory, a reduced bone turnover will reduce the capacity of bone to repair microfactures, resulting in an increased fracture risk independent of bone mass. No particular effect of ABD on bone mineral density (BMD) should be expected, and this is generally found to be the case [12, 20, 21]. Indeed, one study [12]found the development of ABD to be associated with a rising BMD.…”

“…No particular effect of ABD on bone mineral density (BMD) should be expected, and this is generally found to be the case [12, 20, 21]. Indeed, one study [12]found the development of ABD to be associated with a rising BMD. HPT poses the greatest risk for bone loss in most studies [22, 23, 24, 25, 26, 27, 28, 29, 30, 31], with the occasional exception [32].…”

Downregulation of parathyroid hormone receptor gene expression and osteoblastic dysfunction associated with skeletal resistance to parathyroid hormone in a rat model of renal failure with low turnover bone

“…Recently, there has been an increase in the prevalence of ABD in dialysis patients [4], and low PTH levels are frequently seen in chronic renal failure patients with ABD [4]. In addition, it has been reported that ABD is associated with increased fracture rate [5], brittle calcium control [6] and increased vascular calcification [7]. Since vascular calcification is currently recognized as a risk factor for mortality in patients with end-stage renal disease [8], elucidating the mechanisms underlying the development of ABD is essential to improve quality of life and prognosis.…”

Effects of Thyroparathyroidectomy, Exogenous Calcium, and Short-Term Calcitriol Therapy on the Growth Plate in Renal Failure

“…Adynamic bone is characterized by low to normal serum intact parathyroid hormone levels (PTH), low alkaline phosphatase, and episodes of hypercalcemia (3,4). In the skeleton, there is diminished bone formation rate, a decrease in osteoblast and osteoclast number, and a decline in osteoid formation (4 -6).…”