Assessment of Bone and Joint Diseases: Renal Osteodystrophy

Esther A. González, Ziyad Al Aly, Kevin J. Martin

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Renal ostodystrophy represents a complex disorder of bone metabolism resulting from the many derangements that occur during the course of chronic kidney disease. The patterns of bone disease revealed by histological examination of bone lead to useful classifications of the disorder and provide specific diagnostic information. The many non-invasive tools that may be utilized for the assessment of bone metabolism are clinically useful when considered together, especially when serial measurements are available. An understanding of the pathogenesis of renal ostodystrophy and early therapy directed at these pathogenetic factors are important to minimize the significant morbidity that occurs as a result of this complication of chronic kidney disease. The majority of patients with end stage renal diseases have abnormal bone histology. These skeletal abnormalities, generically termed renal ostodystrophy, encompass the manifestations of hyperparathyroidism on bone (osteitis fibrosa), a disorder of low bone turnover (adynamic bone), abnormalities of bone mineralization (osteomalacia), and combinations of these abnormalities (mixed renal ostodystrophy), together with the accumulation of retained ions such as aluminum, iron, cadmium, oxalate, as well as the deposition of proteins such as ?2 microglobulin. It is also important to consider that the final manifestations in bone may be tempered by a prior therapy for specific renal diseases, for example, corticosteroids, inactivity as a consequence of chronic kidney disease, ovarian failure (either due to drug therapy or uremia), as well as advancing age. These confounding factors may complicate the final pattern of bone histology and, in addition, may influence the changes over time and the responses to therapeutic interventions.

Original languageEnglish
Title of host publicationDynamics of Bone and Cartilage Metabolism
Subtitle of host publicationPrinciples and Clinical Applications
Number of pages11
ISBN (Print)9780120885626
StatePublished - Jul 24 2006


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