Strontium overload and toxicity: impact on renal osteodystrophy

Area of Science:

• Nephrology
• Bone Metabolism
• Toxicology

Background:

• Aluminium-related bone disease prevalence has decreased, but osteomalacia persists.
• Shifting renal disease treatment regimens correlate with changes in bone disease prevalence.
• Strontium accumulation in bone is increasingly associated with osteomalacia.

Purpose of the Study:

• To investigate the association between strontium accumulation and osteomalacia in renal disease patients.
• To explore the potential synergistic effects of metal accumulation in bone.
• To identify sources of strontium contamination in dialysis fluids.

Main Methods:

• Review of studies on strontium uptake and dose-dependency in bone.
• Analysis of animal studies on strontium effects on mineralization in chronic renal failure.
• Examination of bone biopsies from dialysis patients for strontium and aluminium content.
• Correlation analysis of strontium levels in dialysis fluids and patient serum.

Main Results:

• Strontium accumulation in bone is dose-dependent and localized in newly formed bone.
• High strontium doses induce mineralization defects and significant bone accumulation in animal models.
• Dialysis patients with osteomalacia show elevated bone strontium levels and strontium/calcium ratios.
• Strontium contamination in dialysis fluids, potentially from acetate-based concentrates, correlates with patient strontium levels.
• Bone strontium content is higher in osteomalacic patients compared to other renal bone diseases and controls.

Conclusions:

• Strontium accumulation is a significant factor in the pathogenesis of osteomalacia in renal disease.
• Contaminated dialysis fluids represent a potential source of strontium exposure.
• Further evaluation of environmental and medical trace metal exposure is crucial to prevent renal osteopathies.