Assessment of osteodystrophy in patients with chronic renal failure

Nine patients with chronic renal failure were followed for more than one year by serial bone biopsies which were assessed by quantitative histological techniques. All patients had evidence of bone disease; this progressed during the interbiopsy period in eight. Patients who had the most advanced histologic disease at initial biopsy showed the most progression in resorption and demineralization, but with greater progression of hyperparathyroid bone disease than osteomalacia. The type of bone disease and its rate of progression could only be accurately assessed histologically. No predictive parameters of early bone disease were found from clinical history, biochemistry or radiology. Raised serum alkaline phosphatase occurred only in advanced hyperparathyroid bone disease. Minor radiological abnormalities in magnified views of the hands were indicative of histologically advanced asymptomatic hyperparathyroidism.