Skeletal surveys in renal osteodystrophy

The authors reviewed the clinical usefulness of routine comprehensive skeletal surveys in monitoring renal osteodystrophy in 66 patients on chronic maintenance hemodialysis. Only fourteen (22%) of the 66 patients had roentgenographic evidence of hyperparathyroid bone disease. There were no significant differences in serum calcium, phosphate, or aluminum levels between patients with and without evidence of phalangeal subperiosteal bone resorption in the hands. However, serum levels of parathyroid hormone (PTH) (both intact and mid-molecule) and alkaline phosphatase values were significantly higher in the group with subperiosteal bone resorption (p less than 0.01 and p less than 0.02, respectively). Serum intact PTH correlated with alkaline phosphatase better than the mid-molecule assay. Neither intact nor mid-molecule PTH values correlated with serum calcium, phosphate, or aluminum. Hand roentgenograms were most sensitive in detecting early changes of hyperparathyroidism; symphysis pubis was the next best. Other skeletal roentgenographic findings were less revealing, and in a subset of 20 patients, roentgenograms correlated poorly with bone histology. During this study the authors found an 8% prevalence of vertebral compression fractures; all in postmenopausal white women.