Radiography of healing dialysis osteodystrophy

Characteristic skeletal changes of dialysis bone disease associated with multiple fractures were found in ten patients on prolonged regular (high aluminium) haemodialysis. A subsequent prospective investigation with serial radiography demonstrated healing approximately twelve months after a changed treatment regime. The treatment used was deionized or reverse osmosis water dialysis and renal transplantation. The typical osteomalacic and osteosclerotic changes and particularly metaphyseal sclerosis were found to be associated with more rapid clinical healing, whereas secondary hyperparathyroidism indicated delayed healing. It is suggested that plasma aluminium imbalance may lead to disturbance of bone formation with fractures, while healing is associated with normal serum aluminium levels and is manifested radiologically by osteosclerosis, particularly in the metaphyses.