Treatment of dialysis osteomalacia with desferrioxamine

Two patients with severe dialysis osteomalacia, whose fractures and deformities had become progressively worse over 3 years, were treated with desferrioxamine (DFO). They improved rapidly and over 6 months were able to stop taking analgesics and return to normal activities. Pre-treatment bone biopsy samples contained extensive osteoid covering trabecular surfaces. Electron microscopy showed morphological abnormalities in the matrix. Treatment brought about a decrease in the extent and depth of osteoid, but matrix abnormalities remained. Energy-dispersive X-ray microanalysis showed the presence of several metals not seen in normal bone. The changes in trace metals after DFO treatment were not consistent. Atomic absorption analysis showed no significant change in the aluminium content of bone with treatment. DFO appears to be an effective treatment for severe dialysis osteomalacia.