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Intern Med J 2018 Dec;48(12):1435-1446

Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.

The metabolic abnormalities affecting bone in the setting of chronic kidney disease (CKD) are complex with overlapping and interacting aetiologies and have challenging diagnostic and management strategies. Disturbances in calcium, phosphate, fibroblast growth factor 23, parathyroid hormone concentrations and vitamin D deficiency are commonly encountered and contribute to the clinical syndromes of bone disorders in CKD, including hyperparathyroidism, osteomalacia, osteoporosis and adynamic bone disease. Mineral and bone abnormalities may also persist or arise de novo post-renal transplantation. Read More

Bone Rep 2018 Jun 17;8:125-134. Epub 2018 Mar 17.

Bone & Mineral Research Laboratory, Henry Ford Health System, Detroit, MI, 48201, United States.

With the widespread use of measurement of bone mineral density to detect, diagnose, and monitor therapy in the management of osteoporosis, bone histomorphometry has largely been relegated to research settings and academic pursuits. However, bone density measurement cannot distinguish between osteoporosis and other metabolic bone disorders such as different types of osteomalacia, osteitis fibrosa, renal osteodystrophy, hypophosphatasia, and Paget's disease of bone. Furthermore, bone density test cannot tell us anything about microarchitecture of bone, tissue level dynamics, bone cellular activity, bone mineralization and bone remodeling, understanding of which is essential to make a specific diagnosis of a suspected metabolic bone disease, to evaluate beneficial (or adverse) effects of various therapies, treatment (medical or surgical) decisions in hyperparathyroid states. Read More

Int J Mol Med 2018 Sep 13;42(3):1603-1614. Epub 2018 Jun 13.

Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China.

Hypophosphatemic rickets/osteomalacia is characterized by defective renal phosphate reabsorption and abnormal bone mineralization. Hypophosphatemic rickets/osteomalacia consists of inherited and acquired forms, many of which have unknown aetiology. In the present study, next‑generation sequencing‑based resequencing was used on samples from Chinese subjects with hypophosphatemic rickets/osteomalacia, aiming to detect the spectrum of pathogenic genes in these patients. Read More

Front Endocrinol (Lausanne) 2018 20;9:48. Epub 2018 Feb 20.

Department of Molecular Endocrinology, Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan.

Fibroblast growth factor 23 (FGF23) is a phosphotropic hormone mainly produced by bone. FGF23 reduces serum phosphate by suppressing intestinal phosphate absorption through reducing 1,25-dihydroxyvitamin D and proximal tubular phosphate reabsorption. Excessive actions of FG23 result in several kinds of hypophosphatemic rickets/osteomalacia including X-linked hypophosphatemic rickets (XLH) and tumor-induced osteomalacia. Read More

G Ital Nefrol 2017 Dec 5;34(Nov-Dec). Epub 2017 Dec 5.

Department of Medicine, Section of Internal Medicine D, University of Verona, Italy.

Histomorphometry or quantitative histology is the analysis on histologic sections of bone resorption, formation and structure parameters. It is the only technique allowing a dynamic evaluation of osteoblast activity after labelling with tetracycline. In addition, the use of computed image analyzer allows the possibility to assess bone microarchitecture. Read More

Endocrinol Metab Clin North Am 2017 12 29;46(4):983-1007. Epub 2017 Sep 29.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA. Electronic address:

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with abnormalities in bone and mineral metabolism, known as CKD-bone mineral disorder. CKD and ESRD cause skeletal abnormalities characterized by hyperparathyroidism, mixed uremic osteodystrophy, osteomalacia, adynamic bone disease, and frequently enhanced vascular and ectopic calcification. Hyperparathyroidism and mixed uremic osteodystrophy are the most common manifestations due to phosphate retention, reduced concentrations of 1,25-dihydroxyvitamin D, intestinal calcium absorption, and negative calcium balance. Read More

Adv Clin Chem 2017 7;82:1-46. Epub 2017 Aug 7.

David Geffen School of Medicine, University of California, Los Angeles, CA, United States. Electronic address:

Calcium and inorganic phosphate are of critical importance for many body functions, thus the regulations of their plasma concentrations are tightly controlled by the concerted actions of reabsorption/excretion in the kidney, absorption in the intestines, and exchange from bone, the major reservoir for calcium and phosphate in the body. Parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,25(OH)D) control calcium homeostasis, whereas PTH, 1,25(OH)D, and bone-derived fibroblast growth factor 23 (FGF 23) control phosphate homeostasis. Hypoparathyroidism can cause hypocalcemia and hyperphosphatemia, whereas deficient vitamin D actions can cause osteomalacia in adults and rickets in children. Read More

Med Arch 2017 Apr;71(2):151-153

Department of Orthopedics and Traumatology, General hospital Niksic, Montenegro.

Introduction: Subcapital femoral neck fractures are associated with high morbidity and mortality. These fractures mostly occur as a result of a high-force impact from traffic accidents and a fall from a great height, though non-traumatic forms are described in transient osteoporosis during the second half of pregnancy, in convulsions during electric shock, eclampsia, hypocalcemia, osteomalacia, renal osteodystrophy and myeloma.

Case Report: In this report we present a bilateral subcapital femoral neck fracture in a woman sustained two days after delivery. Read More

Am J Kidney Dis 2017 Sep 9;70(3):445-448. Epub 2017 May 9.

Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Bone deformities and fractures are common consequences of renal osteodystrophy in the dialysis population. Persistent hypophosphatemia may be observed with more frequent home hemodialysis regimens, but the specific effects on the skeleton are unknown. We present a patient with end-stage renal disease treated with frequent home hemodialysis who developed severe bone pain and multiple fractures, including a hip fracture and a tibia-fibula fracture complicated by nonunion, rendering her nonambulatory and wheelchair bound for more than a year. Read More

Semin Dial 2017 07 5;30(4):361-368. Epub 2017 Apr 5.

Department of Medicine, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

Musculoskeletal manifestations in chronic kidney disease (CKD) are the result of a series of complex alterations in mineral metabolism, which has been defined as chronic kidney disease - mineral and bone-related disorder (CKD-MBD). Biochemical assessment and, at times, bone biopsy remains the mainstay of disease assessment, however, radiological imaging is an important adjunct in evaluating disease severity. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, osteopenia, and extra-skeletal calcifications. Read More

Int J Surg Case Rep 2016 17;28:321-324. Epub 2016 Oct 17.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.

Introduction: Simultaneous bilateral femoral neck fracture is an uncommon condition. There are very few cases reported in the literature and most of these cases have underlying bone pathologies such as renal osteodystrophy and osteomalacia. In some cases bilateral femoral neck fractures occur due to generalized seizures or high-energy trauma. Read More

Radiographics 2016 Oct;36(6):1871-1887

From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.).

Metabolic bone diseases are a diverse group of diseases that result in abnormalities of (a) bone mass, (b) structure mineral homeostasis, (c) bone turnover, or (d) growth. Osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. Impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. Read More

J Clin Transl Endocrinol 2016 Sep 25;5:32-35. Epub 2016 Jul 25.

Division of Endocrinology, Diabetes, and Metabolism, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USA.

The Kidney Disease: Improving Global Outcomes (KDIGO) work group released recommendations in 2006 to define the bone-related pathology associated with chronic kidney disease as renal osteodystrophy. In 2009, KDIGO released revised clinical practice guidelines which redefined systemic disorders of bone and mineral metabolism due to chronic kidney disease as chronic kidney disease-mineral and bone disorders. Conditions under this overarching term include osteitis fibrosa cystica, osteomalacia, and adynamic bone disease. Read More

Clin Nephrol 2016 Mar;85(3):127-34

Aims: The aim of this study was to evaluate the associations between bone histomorphometry and bone volume measured by dual-energy X-ray absorptiometry (DXA) in wait-listed dialysis patients. Further, the circulating markers of mineral metabolism and bone turnover were compared.

Material And Methods: Bone biopsies were performed on 61 wait-listed dialysis patients. Read More

Clin J Am Soc Nephrol 2016 Mar 28;11(3):481-7. Epub 2015 Dec 28.

Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California; and

Background And Objectives: Computed tomography (CT) measurements can distinguish between cortical and trabecular bone density in vivo. High-resolution CTs assess both bone volume and density in the same compartment, thus potentially yielding information regarding bone mineralization as well. The relationship between bone histomorphometric parameters of skeletal mineralization and bone density from microcomputed tomography (μCT) measurements of bone cores from patients on dialysis has not been assessed. Read More

BMC Nephrol 2015 Nov 11;16:187. Epub 2015 Nov 11.

Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Background: Primary biliary cirrhosis (PBC) is an immune-mediated chronic cholestatic liver disease, characterized by increased concentrations of serum IgM and the presence of circulating anti-mitochondrial antibodies. Although bone diseases such as osteoporosis or osteodystrophy are commonly associated with PBC, osteomalacia which is caused by abnormal vitamin D metabolism, mineralization defects, and phosphate deficiency has not been recognized as a complication of PBC.

Case Presentation: We report the case of a 49-year-old Japanese woman who complained of multiple fractures. Read More

Endocr Dev 2015 12;28:119-33. Epub 2015 Jun 12.

Department of Paediatric Endocrinology, Royal London Hospital, Whitechapel, London, UK.

Rickets is a condition in which there is failure of the normal mineralisation (osteomalacia) of growing bone. Whilst osteomalacia may be present in adults, rickets cannot occur. It is generally caused by a lack of mineral supply, which can either occur as a result of the deficiency of calcium (calciopaenic rickets, now known as parathyroid hormone-dependent rickets) or of phosphate (phosphopaenic rickets, now called FGF23-dependent rickets). Read More

Pediatr Transplant 2015 Mar 17;19(2):E33-6. Epub 2014 Dec 17.

Pediatric Nephrology and Dialysis Unit, Children's Hospital Giovanni XXIII, Bari, Italy.

Uremic osteodystrophy is an expected complication in subjects with chronic renal insufficiency. It develops gradually and progressively already during the conservative treatment and then during the dialysis treatment. It can present a wide histopathological spectrum including typical alterations (from osteitis fibrosa to osteomalacia and/or mixed lesions) or, more rarely, isolated bone lesions indicative of a brown tumor of the bone. Read More

Head Neck Pathol 2014 Dec 20;8(4):475-81. Epub 2014 Nov 20.

Pathology, School of Oral Health Sciences, Medunsa Campus, University of Limpopo, Pretoria, 0204, South Africa,

Metabolic bone diseases often are asymptomatic and progress sub clinically. Many patients present at a late stage with catastrophic skeletal and extra skeletal complications. In this article, we provide an overview of normal bone remodeling and a synopsis of recent developments in the following conditions: osteoporosis, rickets/osteomalacia, endocrine-induced bone disease, chronic kidney disease-mineral bone disorder and Paget's disease of bone. Read More

Kidney Int 2015 Apr 22;87(4):846-56. Epub 2014 Oct 22.

Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium.

The multicenter, single-arm BONAFIDE study characterized the skeletal response to cinacalcet in adult dialysis patients with plasma parathyroid hormone (PTH) levels of 300 pg/ml or more, serum calcium of 8.4 mg/dl or more, bone-specific alkaline phosphatase over 20.9 ng/ml and biopsy-proven high-turnover bone disease. Read More

Curr Opin Nephrol Hypertens 2014 Jul;23(4):431-7

Department of Medicine, Columbia University Medical Center, New York, New York, USA.

Purpose Of Review: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a complex disorder of bone and mineral metabolism that results in an excess risk of fractures, cardiovascular events and mortality. The management of the bone disorder aspect of CKD-MBD may require bone biopsy to determine appropriate treatment strategies. However, it is unclear when biopsy may be necessary and whether or not state-of-the art imaging and serologic testing can supplant the bone biopsy as a tool to assist with management decisions. Read More

ScientificWorldJournal 2013 31;2013:837573. Epub 2013 Dec 31.

Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien, New Taipei 231, Taiwan.

Patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) have a high risk of bone fracture because of low bone mineral density and poor bone quality. Osteoporosis also features low bone mass, disarranged microarchitecture, and skeletal fragility, and differentiating between osteoporosis and CKD-MBD in low bone mineral density is a challenge and usually achieved by bone biopsy. Bisphosphonates can be safe and beneficial for patients with a glomerular filtration rate of 30 mL/min or higher, but prescribing bisphosphonates in advanced CKD requires caution because of the increased possibility of low bone turnover disorders such as osteomalacia, mixed uremic osteodystrophy, and adynamic bone, even aggravating hyperparathyroidism. Read More

Contrib Nephrol 2013 3;180:1-13. Epub 2013 May 3.

Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA.

Phosphate is widely distributed in the body and an adequate balance is required for maintaining essential cellular and organ functions. Dysregulation of phosphate balance, either in the form of hypophosphatemia or hyperphosphatemia can induce disorders ranging from rickets/osteomalacia to cardiovascular calcification. A physiologic phosphate balance is delicately maintained by multiorgan cross-talks among the intestine, kidney, and bone. Read More

Nephrourol Mon 2012 24;4(4):613-6. Epub 2012 Sep 24.

Internal Medicine and Nephrology Department, Faculty of Health Sciences, University Gaston Berger, Saint-Louis, Senegal.

Background: Chronic kidney disease related mineral and bone disease (CKD-MBD) is a worldwide challenge in hemodialysis patients. In Senegal, number of dialysis patients is growing but few data are available about their bone disorders.

Objectives: To describe patterns of CKD-MBD in Senegalese dialysis patients. Read More

Clin Radiol 2013 Jul 21;68(7):e397-411. Epub 2013 Mar 21.

Department of Diagnostic Radiology, Singapore General Hospital, Singapore.

Musculoskeletal manifestations in chronic renal insufficiency are caused by complex bone metabolism alterations, now described under the umbrella term of chronic kidney disease mineral- and bone-related disorder (CKD-MBD), as well as iatrogenic processes related to renal replacement treatment. Radiological imaging remains the mainstay of disease assessment. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, soft-tissue calcifications; as well as features associated with renal replacement therapy, such as aluminium toxicity, secondary amyloidosis, destructive spondyloarthropathy, haemodialysis-related erosive arthropathy, tendon rupture, osteonecrosis, and infection. Read More

Intern Med 2012 1;51(23):3277-80. Epub 2012 Dec 1.

Nephrology Center, Toranomon Hospital, Japan.

A 61-year-old Japanese woman on hemodialysis with autosomal dominant polycystic kidney disease (ADPKD) was admitted to the hospital with gluteal pain. Radiographs demonstrated a fracture of the left pubis. The serum 1,25(OH)(2)-vitamin D and 25(OH)-vitamin D levels were low. Read More

Joint Bone Spine 2012 Dec 21;79(6):544-9. Epub 2012 Nov 21.

INSERM U1059, université de Lyon, Saint-Étienne cedex 2, France.

Chronic kidney disease (CKD) alters the metabolism of several minerals, thereby inducing bone lesions and vessel-wall calcifications that can cause functional impairments and excess mortality. The histological bone abnormalities seen in CKD, known as renal osteodystrophy, consist of alterations in the bone turnover rate, which may be increased (osteitis fibrosa [OF]) or severely decreased (adynamic bone disease [AD]); abnormal mineralization (osteomalacia [OM]), and bone loss. Secondary hyperparathyroidism is related to early phosphate accumulation (responsible for FGF23 overproduction by bone tissue), decreased calcitriol production by the kidneys, and hypocalcemia. Read More

Int Urol Nephrol 2013 Dec 19;45(6):1795-9. Epub 2012 Sep 19.

LUNAM Université, Angers, France,

Transient hypophosphatemia is frequently observed during the first months after renal transplantation and is usually asymptomatic. Phosphate diabetes is defined as inadequate tubular phosphorus reabsorption leading to persistent renal phosphorus wasting, which is an important but overlooked cause of osteodystrophy in the post-renal transplantation population. We report the case of a 58-year-old male who presented with severe multiple osteoarticular pains within 3 months after successful first kidney transplantation. Read More

J Clin Endocrinol Metab 2012 Nov 11;97(11):3851-6. Epub 2012 Sep 11.

Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.

Context: Slipped capital femoral epiphysis is a well-recognized skeletal complication of renal osteodystrophy in adolescence, which is distinct from idiopathic slipped capital femoral epiphysis in its etiology.

Objective: We report a case of severe mixed-type renal osteodystrophy with metaphyseal bone collapse that mimicked slipped capital femoral epiphyses.

Methods: Case history, laboratory and radiological evaluation, and bone biopsies are discussed. Read More

South Med J 2012 Sep;105(9):479-85

Division of Nephrology, Department of Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USA.

The term renal osteodystrophy describes the pathological changes in bone structure in chronic kidney disease (CKD); however, this term fails to describe adequately the adverse changes in mineral and hormonal metabolism in CKD that have grave consequences for patient survival. CKD-mineral and bone disorder (CKD-MBD) is a broader, newly defined term that should be used instead of renal osteodystrophy to define the mineral, bone, hormonal, and calcific cardiovascular abnormalities that are seen in CKD. The new paradigm in the management of renal bone disease is to "think beyond the bones" and strive to improve cardiovascular outcomes and survival. Read More

Transplant Proc 2012 Apr;44(3):680-3

Department of Urology, Kidney Center, Toda Central General Hospital, Saitama, Japan.

Objectives: We expect that if chronic renal failure (CRF) is improved after renal transplantation (RTx), dialysis osteopathy bone lesions would also recover to normal. Nevertheless, it is controversial whether bone lesions really improve after RTx. In this study, we evaluated whether pathological dialysis osteopathy improved after RTx. Read More

Crit Rev Eukaryot Gene Expr 2012 ;22(1):61-86

Department of Internal Medicine, The Kidney Institute and Division of Nephrology-Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA.

More than 300 million years ago, vertebrates emerged from the vast oceans to conquer gravity and the dry land. With this transition, new adaptations occurred that included ingenious changes in reproduction, waste secretion, and bone physiology. One new innovation, the egg shell, contained an ancestral protein (ovocleidin-116) that likely first appeared with the dinosaurs and was preserved through the theropod lineage in modern birds and reptiles. Read More

Clin Calcium 2011 Sep;21(9):1388-92

Ito Bone Histomorphometry Institute, Japan.

Histological analysis of undecalcified bone biopsy specimens is a valuable clinical and research tool for studying the etiology, pathogenesis and treatment of metabolic bone diseases. In case of osteoporosis, bone biopsy is not usually required for the diagnosis ; however, bone histomorphometry may be useful in rare cases with unusual skeletal fragility. Bone histomorphometry also provides valuable information on the mechanism of action, safety and efficacy of new anti-osteoporosis drugs. Read More

J Bone Miner Metab 2011 Sep 6;29(5):507-14. Epub 2011 Aug 6.

Division of Nephrology and Endocrinology, Department of Medicine, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.

Fibroblast growth factor 23 (FGF23) is produced by bone and reduces serum phosphate by inhibiting proximal tubular phosphate reabsorption and intestinal phosphate absorption. Excess actions of FGF23 cause several kinds of hypophosphatemic rickets/osteomalacia while deficient actions of FGF23 result in hyperphosphatemic tumoral calcinosis. In addition, FGF23 has been shown to prevent the development of hyperphosphatemia during the progression of chronic kidney disease-mineral and bone disorder. Read More

Semin Diagn Pathol 2011 Feb;28(1):13-25

Department of Pathology, University of California, San Francisco, San Francisco, California 94402, USA.

Clin Calcium 2011 Apr;21(4):593-7

Institute of Kidney Diseases, Itabashi Chuo Medical Center.

Global Kidney Disease Guideline Organization ; KDIGO has decided to express the abnormality in bone and mineral metabolism associated with chronic kidney disease (CKD) as CKD-Mineral Bone Disorder (CKD-MBD) . The term "renal osteodystrophy" is now only used for expressing bone pathological abnormality diagnosed by biopsy. The classical classification of bone pathology in CKD is superseded by new T (Turnover) M (mineralization) V (Volume) classification. Read More

Toxicol Pathol 2010 Aug 9;38(5):730-7. Epub 2010 Jul 9.

Kumamoto Laboratory, Toxicological Science Division, Medi-Chem Business Segment, Mitsubishi Chemical Medience Corporation, Kumamoto 869-0425, Japan.

Itai-itai disease (IID) of humans is one of the most severe forms of chronic cadmium (Cd) intoxication. Itai-itai disease occurs mainly in post-menopausal women and is characterized by osteoporosis with osteomalacia, renal tubular disorder, and renal anemia. Some researchers insist the major cause of IID is not Cd, but rather malnutrition, especially hypovitaminosis D. Read More

Arch Biochem Biophys 2010 Nov 3;503(1):95-102. Epub 2010 Jul 3.

Department of Clinical Science, Sapienza University of Rome, Italy.

Renal tubular diseases may present with osteopenia, osteoporosis or osteomalacia, as a result of significant derangements in body electrolytes. In case of insufficient synthesis of calcitriol, as in renal failure, the more complex picture of renal osteodystrophy may develop. Hypothetically, also disturbed renal production of BMP-7 and Klotho could cause bone disease. Read More

Arq Bras Endocrinol Metabol 2010 Mar;54(2):87-98

Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil.

Bone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation allowing a dynamic analysis. Biopsy is indicated to make the diagnosis of subclinical osteomalacia, to characterize the different forms of renal osteodystrophy and to elucidate cases of unexplained skeletal fragility. Read More

Saudi J Kidney Dis Transpl 2010 Jan;21(1):128-30

New Medical Center Specialty Hospital, P.O. Box 7832, Dubai, United Arab Emirates.

Osteomalacia is a common occurrence world over due to the deficiency in vitamin D and calcium intake. We present here two sisters with features of severe osteomalacia, myopathy and hypophosphatemia hyperparathryroidism and 25(OH)D2, 25(OH)D3and 1,25(OH)D3 levels were very low. Read More

Clin J Am Soc Nephrol 2009 Sep;4(9):1484-1493

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan, USA.

Background And Objectives: Racial differences in mineral metabolism exist in the chronic kidney disease population, especially as it relates to intact parathyroid hormone (iPTH) levels. Few data exist on the relationship of these markers to bone biopsy findings in African-American (AA) hemodialysis patients across the spectrum of renal osteodystrophy (ROD).

Design, Setting, Participants, & Measurements: In prevalent AA hemodialysis subjects, we prospectively evaluated subjects by performing transiliac bone biopsy and correlating biochemical and clinical data to bone histology. Read More

Semin Nephrol 2009 Mar;29(2):122-32

Department of Medicine, University of Washington Medical Center, Seattle, WA 98195-6426, USA.

On bone biopsies from patients with chronic kidney disease, measurements are made of the turnover, mineralization, and volume. Turnover depends on the bone formation rate and bone resorption rate; the former can be measured using tetracycline labelling. The osteoid width and bone apposition rate determine the mineralization rates. Read More

Skeletal Radiol 2009 Sep 5;38(9):841-53. Epub 2009 Mar 5.

Diagnostic Radiology, MSK, Cleveland Clinic, 9500 Euclid Avenue A21, Cleveland, OH 44195, USA.

Objective: To provide an update on imaging of metabolic bone disease based on new developments, findings, and changing practices over the past 30 years.

Materials And Methods: Literature review of osteoporosis, osteomalacia, renal osteodystrophy, Paget's disease, bisphosphonates, with an emphasis on imaging.

Results: Cited references and pertinent findings. Read More

Acta Orthop Traumatol Turc 2008 Aug-Oct;42(4):296-301

Department of Orthopedics and Traumatology, Cerrahpaşa Medicine Faculty of Istanbul University, Istanbul, Turkey.

Renal osteodystrophy is one of the major causes of morbidity in patients receiving long-term dialysis treatment for renal failure and after transplantation. Its clinical implications include high-turnover bone disease, low-turnover bone disease, osteomalacia, osteosclerosis, and osteoporosis. A 13-year-old boy who had been on dialysis treatment for renal failure was admitted with a pathologic supracondylar femur fracture after a minor trauma. Read More

Clin J Am Soc Nephrol 2009 Jan 5;4(1):221-33. Epub 2008 Nov 5.

Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia.

Cardiovascular disease is highly prevalent in chronic kidney disease (CKD) and is often associated with increased vascular stiffness and calcification. Recent studies have suggested a complex interaction between vascular calcification and abnormalities of bone and mineral metabolism, with an inverse relationship between arterial calcification and bone mineral density (BMD). Although osteoporosis is recognized and treated in CKD 1 to 3, the interpretation of BMD levels in the osteoporotic range is controversial in CKD 4, 5, and 5D when renal osteodystrophy is generally present. Read More

Clin Nephrol 2008 Oct;70(4):284-95

Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY 40536, USA.

Aims: To investigate the evolution of renal osteodystrophy in patients on maintenance dialysis, treated with lanthanum carbonate (LC) vs. standard phosphate-binder therapy (Stx).

Materials And Methods: This was a 2-year, randomized, prospective, open-label study during which patients on dialysis received LC titrated to a maximum of 3,000 mg/day or their previous phosphate binder treatment with the aim to achieve target phosphorus levels of < or = 5. Read More

Adolesc Med State Art Rev 2007 May;18(1):24-46, viii

Division of Pediatric Endocrinology, Pediatrics Program, Michigan State University/Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.

Bone is a metabolically active organ that undergoes constant remodeling. Bone is very important for maintaining homeostasis of calcium and phosphorous in the body. Disorders of bone metabolism may encompass disease processes involving underactive or overactive bone turnover. Read More

Saudi J Kidney Dis Transpl 1998 Apr-Jun;9(2):128-33

Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.

To evaluate renal osteodystrophy (ROD), bone biopsies were performed in 57 patients with end-stage renal failure (ESRF) on dialysis, 46 on hemodialysis (HD) and 11 on peritoneal dialysis (PD). There were 29 males (mean age of 42 years) and 28 females (mean age of 39 years). Relevant presenting clinical features were pruritus in 46 cases, bone pains in 32, acute pseudogout in three, bone deformities in two, conjunctiva! calcification in two, cutaneous calcification in two, and corneal calcification in one. Read More

Instr Course Lect 2008 ;57:575-93

Treadwell Library and Smith-Peterson Library, Massachusetts General Hospital, Boston, Massachusetts, USA.

Understanding the structure and formation of bone and the metabolic diseases that cause intrinsic biochemical alterations and ultimate damage to the skeletal system is an essential part of orthopaedic education and knowledge. Metabolic bone diseases such as rickets, osteomalacia, renal osteodystrophy, hyperparathyroidism, and osteoporosis often lead to subtle alterations in the patient's clinical status and to severe and disabling changes in the patient's bone structure. It is essential that orthopaedists recognize these conditions, provide a correct diagnosis, and use appropriate preventive and therapeutic treatments. Read More

J Med Case Rep 2008 Mar 11;2:79. Epub 2008 Mar 11.

Registrar, Department of Trauma and Orthopaedics, St Georges Hospital, Blackshaw Rd, London, UK.

Introduction: We present an interesting and unusual case of a 61-year-old woman with bilateral, undisplaced, stress neck of femur fractures associated with short-term steroid use. Insufficiency fractures of the neck of femur without preceding trauma have been described in the literature, although bilateral involvement is infrequent. These fractures have been associated with strenuous exercise, seizures, renal osteodystrophy, fluoride treatment, long-term corticosteroid use, amenorrhoea, abnormal anatomy and osteomalacia due to nutritional and/or hormonal factors. Read More