scholarly journals The spectrum of bone disease in 200 chronic hemodialysis patients: a correlation between clinical, biochemical and histological findings

1998 ◽  
Vol 116 (5) ◽  
pp. 1790-1797 ◽  
Author(s):  
Maria Eugênia Leite Duarte ◽  
Ana Lúcia Passos Peixoto ◽  
Andréa da Silva Pacheco ◽  
Angela Vieira Peixoto ◽  
Rodrigo Dezerto Rodriguez ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Lesion ◽  
Clinical Manifestations ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Histological Findings ◽  
Phosphate Binding ◽  
High Turnover

INTRODUCTION: Renal osteodystrophy includes the complete range of mineral metabolism disorders that affect the skeleton in patients with chronic renal failure. PATIENTS AND METHODS: 200 patients with end-stage renal disease and on dialysis were investigated regarding the clinical, biochemical and histological findings of bone disease. RESULTS: The spectrum of renal osteodystrophy consisted mainly of high turnover bone lesions (74.5%), including osteitis fibrosa in 57.5%. Patients with mild bone disease were on dialysis for shorter periods of time and were mostly asymptomatic. Patients with aluminum-related bone disease (16.5%) had the greatest aluminum exposure, either orally or parenterally, and together with patients with high turnover mixed disease, were the most symptomatic. Although on a non-regular basis, the vast majority of the patients (82.5%) had been receiving vitamin D. The incidence of adynamic bone disease was high (n=8) among parathyroidectomized patients (n=12). Significantly higher serum levels of alkaline phosphatase were observed in osteitis fibrosa. CONCLUSIONS: The use of calcitriol and phosphate-binding agents on a non-regular basis seems to be the reason for the apparent reduced response to the treatment of secondary hyperparathyroidism. Alkaline phosphatase has been shown to be a fair marker for bone turnover in patients with osteitis fibrosa. The severity of the clinical manifestations of bone disease correlates with the histological features of bone lesion and to the time spent on dialysis.

Renal Osteodystrophy in Pre-Dialysis Patients: Ethnic Difference?

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 402-407 ◽  
Author(s):  
Sug Kyun Shin ◽  
Do Hun Kim ◽  
Heung Su Kim ◽  
Kyu Tae Shin ◽  
Kyung Ae Ma ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Ethnic Difference ◽  
Osteitis Fibrosa ◽  
Dialysis Patients ◽  
Total Alkaline Phosphatase ◽  
Intact Pth ◽  
Western Countries ◽  
Total Alkaline

The purpose of the present study is to investigate whether an ethnic difference exists in the incidence of renal osteodystrophy between Asian and Western countries in end-stage renal disease (ESRD) patients. We evaluated bone histology in 58 pre-dialysis patients (28 male, 30 female; mean age: 47.7 years). All patients had bone biopsies with quantitative histomorphometry and sero-logical parameters such as intact PTH, osteocalcin, total alkaline phosphatase, and basal and deferoxamine-stimulated serum aluminum levels. We observed that 91.4% of all evaluated patients showed renal osteodystrophy before the start of dialytic therapy. Mild osteitis fibrosa were observed in 21 patients (36.2%), severe osteitis fibrosa in 5 patients (8.6%), mixed lesions in 7 patients (12.1 %), osteomalacia in 6 patients (10.3%), aplastic bone disease in 14 patients (24.1%), and normal bone in 5 patients (8.6%). Among the bone histomorphometric parameters, fibrosis area rate (%) showed the best correlation with intact PTH, and osteocalcin and osteoid area rate (%) with total alkaline phosphatase. Aluminum-related bone disease was not observed. Among patients with aplastic bone disease, only 14.3% showed aluminum deposition of any significance (5% < stainable bone surface aluminum < 25%). In the diabetic patients, aplastic bone disease was most common, but no case was related to aluminum intoxication. In conclusion, the distribution of renal osteodystrophy in our study was different from that of Western countries in pre-dialysis patients. Our patients tended to have more mild-form osteitis fibrosa and normal findings, and less severe-form osteitis fibrosa and aplastic bone disease. Aluminum-related bone disease was not observed.

Renal Osteodystrophy in Peritoneal Dialysis: Special Considerations

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 11-19 ◽  
Author(s):  
Ronen Levy ◽  
Anca Gal-Moscovici
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Lesion ◽  
Phosphate Binders ◽  
Vitamin D Metabolites ◽  
Bone Disorder

Bone disease is one of the most challenging complications in patients with chronic kidney disease. Today, it is considered to be part of a complex systemic disorder manifested by disturbances of mineral metabolism and vascular calcifications called chronic kidney disease – mineral bone disorder (CKD-MBD). The term renal osteodystrophy is reserved to define the specific bone lesion in CKD-MBD, whose spectrum ranges from high turnover to low turnover disease. Phosphate retention, decreased serum calcium, and 1,25-dihydroxy vitamin D synthesis are involved in the pathogenesis of high bone turnover. However, the various therapeutic approaches (calcium supplements, phosphate binders, and vitamin D metabolites, among others), the renal replacement modality (hemodialysis or continuous ambulatory peritoneal dialysis), and the types of patients to whom dialysis is offered (more patients who are diabetic or older, or both) may influence the evolution of the bone disorder. As a result, recent studies have reported a greater prevalence of adynamic forms of renal osteodystrophy, especially in diabetic and peritoneal dialysis patients. The present article reviews, for patients treated with peritoneal dialysis, the pathophysiologic mechanisms involved in the evolution and perpetuation of this bone disease and the therapeutic modalities for treating and preventing adynamic bone.

Metabolic Bone Disease in the CAPD Patient

1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 24-26 ◽  
Author(s):  
Francisco Llach
Keyword(s):  
Vitamin D ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Osteitis Fibrosa ◽  
Prospective Evaluation ◽  
Metabolic Bone ◽  
Capd Patient

It seems that CAPD may improve some patients with osteomalacia but may be similar to hemodialysis in regard to osteitis fibrosa. However, long-term prospective evaluation of the incidence of bone disease in CAPD patients is necessary before we can determine how CAPD may alter the incidence and expression of renal osteodystrophy. We need more information before we can conclude that CAPD may improve pure osteomalacia. Finally, the data available are insufficient to clarify the role of vitamin D analogues in these patients.

scholarly journals SO07118F-SODIUM FLUORIDE POSITRON EMISSION TOMOGRAPHY AND BONE HISTOMORPHOMETRY - COMPARISON BETWEEN ONLY BONE TURNOVER -BASED AND EXPERT EVALUATION -BASED CLASSIFICATION OF RENAL OSTEODYSTROPHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Louise Caroline Aaltonen ◽  
Niina Koivuviita ◽  
Marko Seppänen ◽  
Inari Burton ◽  
Heikki Kröger ◽  
...  
Keyword(s):  
Bone Turnover ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Biopsy ◽  
Formation Rate ◽  
Adynamic Bone Disease ◽  
High Turnover ◽  
Bone Formation Rate ◽  
Adynamic Bone

Abstract Background and Aims The diagnosis and the differentiation of renal osteodystrophy (ROD) are challenging. Bone biopsy is the golden standard, but it is invasive and not available in every center. Bone turnover rate is defined by bone formation rate and/or activation frequency. Adynamic bone disease is defined as low turnover bone with reduced osteoblast- and osteoclast activities. Hyperparahyreoid bone disease or osteitis fibrosa is defined as high turnover bone with osteoclast- and osteoblast activities and fibrosis. 18F- Sodium Fluoride positron emission tomography (18F-NaF PET) is a noninvasive imaging technique that allows assessment of regional bone turnover. The aim was to assess how well bone turnover –based classification of ROD correlates with the classification determined by an expert histomorphometrist (HK), and how these correlate with 18F-NaF PET analysis Method A total of 24 dialysis patients underwent a 18F-NaF PET scan. Fluoride activity was measured at the anterior iliac crest and in the lumbar region. An iliac crest bone biopsy was obtained within 4 weeks from the PET-scan. The diagnosis of bone histomorphometry was determined based on turnover-mineralization-volume (TMV) classification. Firstly, bone turnover was assessed using bone formation rate and activation frequency. Secondly, also other histomorphometric parameters (eg. osteoid volume, osteoid surface, resorption surface, mineralized surface, osteoblast and osteoclast surfaces and peritrabecular fibrosis) were also taking into account for classification of ROD by a histomorphometrist. Results Based on bone turnover parameters only, 12% of the patients had high turnover and 64% low turnover. When the diagnosis of renal osteodystrophy was made by a histomorphometrist, 40% had hyperparathyreoid bone/osteitis fibrosa and 24% adynamic bone disease or ostemalasia. 18F-NaF PET´s sensitivity to recognize hyperparathyreoid bone disease was 80% end specificity 100% (cut-of value 0.055).18F-NaF PET´s sensitivity to recognize adynamic bone disease was 100% and specificity 61% (cut-of value of fluoride-activity 0.038) Conclusion 18F-NaF PET works well as a diagnostic tool, when the diagnosis of ROD is based on the histopathological evaluation. It remains unknown how variations in normal bone turnover rate can be detected in CKD patients by 18F-NaF PET and if treatment decisions of ROD can be made only based on bone turnover.

Serum osteocalcin enables the differential diagnosis of high turnover renal osteodystrophy (osteitis fibrosa)

1992 ◽  
Vol 17 ◽  
pp. 217
Author(s):  
M Worsfold ◽  
CA Sharp ◽  
J Perks ◽  
MWJ Davie ◽  
JP Day ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Renal Osteodystrophy ◽  
Osteitis Fibrosa ◽  
Serum Osteocalcin ◽  
High Turnover

Technetium-99m Polyphosphate Bone Image for Early Detection of Skeletal Metastasis

1974 ◽  
Vol 13 (04) ◽  
pp. 330-340
Author(s):  
W. H. Blahd ◽  
G. T. Krishnamurthy
Keyword(s):  
Alkaline Phosphatase ◽  
Bone Disease ◽  
Serum Alkaline Phosphatase ◽  
Skeletal Metastasis ◽  
Normal Serum ◽  
Metastatic Bone Disease ◽  
Bone Lesions ◽  
Elevated Alkaline Phosphatase ◽  
Technetium 99M ◽  
Calcium Phosphorus

SummaryTechnetium 99m-polyphosphate bone images are correlated with bone roentgenography, and serum calcium, phosphorus and alkaline phosphatase in 91 patients with suspected bone metastasis. Technetium polyphosphate bone images are the most sensitive and serum level of calcium and phosphorus are the least sensitive indicator of bone lesions. Bone roentgenography is not as sensitive as technetium polyphosphate images. Abnormal bone images with normal or abnormal bone roentenography associated with increased alkaline phosphatase in the absence of liver metastasis are highly suggestive of metastatic bone disease. Abnormal bone images adjoining the joints, associated with normal serum alkaline phosphatase and abnormal joint roentgenography suggest arthritis. It is recommended that technetium 99m-labelled phosphate bone images are considered to be the diagnostic procedure of choice to detect skeletal lesions. Polyphosphate bone images are highly sensitive, with the combination of elevated alkaline phosphatase they become relatively more specific for a metastatic bone disease.

Surgically induced uremia in rats I: Effect on bone strength and metabolism

1993 ◽  
Vol 13 (5) ◽  
pp. 275-287 ◽  
Author(s):  
G. Jablonski ◽  
K. H. Klem ◽  
A. Attramadal ◽  
E. Dahl ◽  
H. Rønningen ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Calcium Phosphate ◽  
Renal Osteodystrophy ◽  
Bone Histomorphometry ◽  
Bone Lesions ◽  
Dihydroxyvitamin D3 ◽  
Blood Electrolytes ◽  
Cross Section Area ◽  
Section Area ◽  
Mechanical Bending

During the course of chronic renal failure (CRF) in man, renal osteodystrophy (osteitis fibrosa and/or osteomalacia) gradually develops. The present study aimed to establish a similar type of CRF leading to renal osteodystrophy in rats. During progressive CRF development over 225 days after 5/6 nephrectomy, the following serum variables were measured: creatinine, immunoreactive parathryoid hormone (iPTH), 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), a25-hydroxyvitamin D3, (25(OH)D3), alkaline phosphatase, albumin, phosphate, urea nitrogen, total calcium, and other blood electrolytes. Subsequent to sacrifice, mechanical properties of the rat femur, bone histomorphometry (osteoid and eroded surfaces) and bone contents of calcium, phosphate and hydroxyproline were also examined. Serum creatinine in rats with CRF gradually escalated by some 70%, while circulating 1,25(OH)2D3 was reduced beneath detection level. Total plasma calcium and phosphate concentrations were, however, almost unchanged indicating that PTH-induced bone remodeling due to moderate hyperparathyroidism sustained calcium homeostasis. Alkaline phosphatase levels were reduced by some 50%, which reflects chronically impeded bone formation. Bone histomorphometry assessment revealed substantial elevation of resorption with moderate accompanying fibrosis in about 70% of afflicted animals. Bone calcium, phosphate and hydroxpyroline contents remained unaltered. However, hydroxoproline/calcium ratio was marginally reduced. These results, together with altered mechanical bending stress characteristics and diminished diaphysis cross section area, confirm development of mixed bone lesions in the uremic animals. Our results are compatible with the early development of CRF in man. The established rat model is therefore useful in elucidating the precipitation and early treatment of renal osteodystrophy in humans.

scholarly journals Osteitis fibrosa cystica mimicking bone tumor, a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maya L. Nasser ◽  
Serge Medawar ◽  
Tonine Younan ◽  
Halim Abboud ◽  
Viviane Trak-Smayra
Keyword(s):  
Bone Tumor ◽  
Metabolic Diseases ◽  
Clinical Symptoms ◽  
Bone Biopsy ◽  
Bone Lesion ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Osteitis Fibrosa Cystica ◽  
Bone Trabeculae ◽  
The Right

Abstract Background We report a case of osteitis fibrosa cystica, a rare benign resorptive bone lesion caused by hyperparathyroidism, that presented on imaging as an aggressive bone tumor. Case presentation The patient is a 51-year-old male complaining of severe sustained pain of the right hip region. Imaging studies were suspicious for a malignant tumor of the right iliac bone. Biopsy under CT guidance was performed and showed remodeled bone trabeculae with numerous osteoclasts, excluding bone tumor and raising the possibility of osteitis fibrosa cystica. Complementary tests disclosed elevated blood level of parathyroid hormone and a partially cystic enlarged left inferior parathyroid gland consistent with adenoma. After parathyroidectomy, the clinical symptoms were relieved and the radiological findings were significantly improved, which confirmed the diagnosis. Conclusions Metabolic diseases-associated bone lesions should always be considered in the differential diagnosis of bone tumors, to avoid unnecessary surgeries and treatments.

scholarly journals A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

2021 ◽  
Author(s):  
Francesca Bacchiarri ◽  
Alessandro Gozzetti ◽  
Nicola Mondanelli ◽  
Stefano Lazzi ◽  
Monica Bocchia
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Bone Disease ◽  
Bone Lesion ◽  
Fatal Outcome ◽  
Lymphocytic Leukemia ◽  
Bone Lesions ◽  
Review Of The Literature ◽  
Skeletal Involvement ◽  
Line Of Therapy

Skeletal involvement in CLL is very rare. We present a case of ileum bone lesion during in a patient receiving 5th line of therapy. Despite radiotherapy and salvage therapies, subsequent bone lesions led to a fatal outcome. Further studies on the mechanism by which bone disease develops are currently needed.

scholarly journals A Patient With Femoral Osteitis Fibrosa Cystica Due To Hyperparathyroidism: A Case Report

2022 ◽  
Author(s):  
Xiaolong Xu ◽  
Cuiping Yang ◽  
Shengjun Lu ◽  
Hong Pei ◽  
Shunguang Chen ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Metabolic Diseases ◽  
Clinical Symptoms ◽  
Serum Alkaline Phosphatase ◽  
Bone Lesion ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Team Approach ◽  
Osteitis Fibrosa Cystica ◽  
The Right

Abstract Background: Osteitis fibrosa cystica is a rare benign, lytic bone lesion attributed to hyperparathyroidism. The high level of parathyroid hormone cause rapid bone loss.Case presentation: The patient is a 50-year-old male complaining of severe sustained pain of the right knee joint. Imaging studies were suspicious for a benign tumor of the right distal femur. Biopsy under CT guidance showed numerous osteoclast aggregation and hemosiderin deposition around the bone trabeculae. Blood tests disclosed significantly elevated parathyroid hormone, serum calcium, serum alkaline phosphatase. Parathyroid ultrasonography and CT scan showed a solid mass in front of the trachea at the thoracic entrance plane. After resection of the mass, the clinical symptoms were relieved and the radiological findings were significantly improved, which further confirmed the diagnosis.Conclusions: Metabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items.An interprofessional team approach to the diagnosis and treatment of Osteitis fibrosa cystica will provide the best outcome.

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