Aplastic osteodystrophy without aluminum: the role of "suppressed" parathyroid function

Area of Science:

• Nephrology
• Bone Metabolism
• Mineral and Bone Disorder

Background:

• Renal osteodystrophy is a common complication in dialysis patients.
• Aluminum toxicity has been a suspected cause of low-turnover bone disease.

Purpose of the Study:

• To evaluate risk factors for various forms of renal osteodystrophy.
• To investigate the role of aluminum and other factors in aplastic bone lesions.

Main Methods:

• Evaluated 259 dialysis patients using serum parathyroid hormone (PTH), deferoxamine infusion test, and iliac crest bone biopsy.
• Assessed changes in PTH levels after adjusting dialysate calcium in patients with aplastic lesions.

Main Results:

• Aplastic lesion was the most common form of renal osteodystrophy (half of biopsied patients).
• Aluminum toxicity was found in only one-third of aplastic lesion cases.
• Peritoneal dialysis, calcium carbonate intake, diabetes mellitus, and advanced age were associated risk factors.
• Lowering dialysate calcium in peritoneal dialysis patients significantly increased PTH levels.

Conclusions:

• Aplastic lesion is the predominant form of renal osteodystrophy.
• Aluminum intoxication is implicated in a minority of aplastic lesion cases.
• Peritoneal dialysis with high dialysate calcium, oral calcium carbonate, and diabetes mellitus are key contributing factors.