The combination of secondary hyperparathyroidism and mineralization defects (osteomalacia) represents the most common form of renal
osteodystrophy (ROD).
Renal
Osteodystrophy is usually a diagnosis of end stage renal disease.
Renal
osteodystrophy, the term used to describe the skeletal complications of CKD, encompasses several bone mineralization abnormalities.
First, the importance of excellent phosphate control to reduce the risk of renal
osteodystrophy and vascular calcification was recognized--yet many of our patients found achieving therapeutic phosphate levels impossible despite major efforts at maximizing therapeutic agents and restricting dietary intake.
Fibrous
osteodystrophy was found in all of the birds from San Antonio and Bryan.
Otosclerosis, an
osteodystrophy limited to the temporal bone (otic capsule), can cause a progressive conductive hearing loss (and occasionally a sensorineural hearing loss if the cochlea is involved).
The hormone is secreted into the circulatory system to produce basal (healthy) concentrations of approximately 15-65 ng/L (1), and is assayed to assist in the diagnosis of hypo/hyperparathyroidism and hypercalcemia and in monitoring for renal
osteodystrophy in patients with end-stage renal failure (1-3).
(9-11) Another study investigating skeletal development in psittacine birds, however, implicated excessive levels of premature exercise in the high rate of juvenile
osteodystrophy seen in hand-reared parrots.
Calcimimetics are still being studied in humans to see if the observed rapid suppression of PTH leads to an improvement in signs of renal
osteodystrophy. Rapid variations in PTH compared to more continuous PTH levels, as in vitamin D3 treatment, could result in potentially unexpected metabolic bone activity.
Table 3 KDIGO[R] Classification of Renal Osteodystrophy/Renal Bone Disease Renal
Osteodystrophy Bone Bone Disorder Turnover Mineralization Osteomalacia Low Abnormal Adynamic bone disease Low Normal Mild hyperparathyroid- Medium Normal related bone disease and to high osteitis fibrosa Mixed uremic High Abnormal
osteodystrophy Renal
Osteodystrophy Bone Disorder Volume Osteomalacia Low to medium Adynamic bone disease Low to normal Mild hyperparathyroid- Variable, depending related bone disease and on the duration of osteitis fibrosa the disease Mixed uremic Normal
osteodystrophy Source: Adapted from Moe et al.
The differential diagnoses included osteopetrosis, Paget disease, hyperparathyroidism, renal
osteodystrophy, osteomalacia, and skeletal fluorosis.
The current classification is based on the presence or absence of Albright hereditary
osteodystrophy (AHO) characterized by brachydactyly, rounded face, short stature, obesity, and subcutaneous ossifications and, the presence or absence of PTH or multiple hormonal resistance together with an in vivo response to exogenous PTH and the results of an in vitro assay to measure Gs[alpha] activity (2).
