[Renal osteodystrophy with diabetic bone disease]

Renal osteodystrophy (ROD) in chronic renal failure (CRF) patients with diabetes mellitus (DM) is characterized by lower degree of secondary hyperparathyroidism and higher prevalence of low turnover bone disorders than that in non-DM CRF patients. Particularly, aplastic bone disease is frequently observed (30 - 40 %). Compared to non-DM CRF patients, serum levels of osteocalcin are significantly decreased, and bone mineral density of trabecular bones is significantly decreased in DM CRF patients. Dietary calcium intake is often less than daily requirement, and hypovitaminosis D is frequently observed. Although persistent hyperglycemic state and impairment of insulin action are major contributors to diabetic osteodystrophy, many factors complicate the feature of DM-CRF. Control of blood glucose levels is the most important to alleviate abnormal bone metabolism in DM-CRF patients, and dietary calcium intake should be normalized. Further, therapeutic strategy of appropriate vitamin D administration should be established, in addition to appropriate exercise therapy, in order to prevent the progression of ROD in DM CRF patients.