Aluminum-associated bone disease in chronic renal failure: high prevalence in a long-term dialysis population
| Autor: | Donald J. Sherrard, Dennis L. Andress, David B. Endres, Norma A. Maloney |
|---|---|
| Rok vydání: | 1986 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology Time Factors Bone disease Endocrinology Diabetes and Metabolism medicine.medical_treatment Biopsy Population Asymptomatic Bone remodeling Lesion Renal Dialysis Internal medicine Medicine Humans Orthopedics and Sports Medicine education Aged education.field_of_study business.industry Osteoid Osteoblast Phosphorus Middle Aged medicine.disease Alkaline Phosphatase Endocrinology medicine.anatomical_structure Parathyroid Hormone Kidney Failure Chronic Calcium Female Hemodialysis medicine.symptom Bone Diseases business Aluminum |
| Zdroj: | Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1(5) |
| ISSN: | 0884-0431 |
| Popis: | Twenty-seven asymptomatic patients treated with hemodialysis longer than 8 years (mean 12.9 ± 3.1 years) underwent bone biopsy to determine the prevalence of aluminum-associated bone disease. None had excess aluminum exposure from the dialysate. Ten patients (37%) had aluminum-associated bone disease as defined by a bone formation rate (BFR) below normal in the presence of stainable bone aluminum that covered more than 25% of the trabecular surface. The predominant type of bone histology in this group was the aplastic lesion characterized by low bone turnover, a decreased number of osteoblasts, and lack of excess unmineralized osteoid. Osteoblastic osteoid was highly correlated with stainable surface bone aluminum (r = - .82, p < .001). Among the dynamic bone parameters, the double-tetracycline labeled surface was a more sensitive indicator of impaired bone function than was the bone apposition rate (BAR), since half of the patients with aluminum-associated bone disease had a normal BAR. In all of the biopsies the extent of double-labeled surfaces was inversely proportional to the amount of stainable aluminum on the bone surface (r = - .71, p < .001), whereas stainable bone aluminum did not correlate with BAR. In seven of the patients with aluminum-associated bone disease, amino-terminal PTH levels were in the normal range while only one patient had a normal plasma mid-region PTH. PTH correlated directly with osteoblastic osteoid, BFR, and double-labeled surfaces. These results indicate that long-term oral aluminum intake in hemodialysis patients results in a high prevalence of aluminum-associated bone disease. The decrease in osteoblast number appears to be the major mechanism for the low bone formation. Whether aluminum adversely affects the osteoblast population directly or decreases osteoblast number indirectly via suppression of PTH secretion remains undecided. |
| Databáze: | OpenAIRE |
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