Early radiographic manifestations of secondary hyperparathyroidism associated with chronic renal disease

The hands of 29 chronic dialysis patients were evaluated every 3 months for subperiosteal, intracortical, and endosteal bone resorption using fine-detail radiography and optical magnification. All patients with significant endosteal resorption also had progressive subperiosteal resorption and substantial or progressive intracortical resorption. All patients with a significantly elevated parathyroid hormone or alkaline phosphatase level had radiographic evidence of progressive bone loss. Fourteen (61%) of the 23 patients with well-controlled serum phosphate levels (mean 4.7 +/- 0.2 mg/dl) treated with supplemental calcium and dihydrotachysterol nevertheless had increased subperiosteal or endosteal resorption. Serial radiography proved to be a valuable method of evaluating progressive bone resorption.