To assess the prevalence of histologic
bone disease in our center where Al(
OH)3 intake is restricted, we reviewed 42 bone biopsies performed between 1975 and 1985 in patients dialyzed more than 29 months. Bone biopsies were performed systematically (2/3 of the cases) or because of a mild
hypercalcemia (1/3 of the cases). Seventeen of these patients had been dialyzed before 1978 with softened water moderately contaminated by
aluminum. Fifteen had always been dialyzed with reverse osmosis treated water and 10 had been exclusively treated by
hemofiltration. The prevalence of
osteitis fibrosa was 76%, that of
osteomalacia null and that of adynamic
bone disease 24% (but only 9.5% with positive
Aluminon staining). When the 17 patients dialyzed with
aluminum contaminated water before 1978 were excluded, only one patient among 25 had an
aluminum adynamic
bone disease (4%). This low prevalence can probably be explained by the restricted intake of Al(
OH)3 thanks to the systematic administration of Ca CO3 and in a few cases of Mg (
OH). The adynamic
bone disease group has lower serum concentration of PTH and shorter duration on dialysis whereas the serum levels of
calcium,
phosphorus,
magnesium and
aluminum and daily dose of Ca CO3, Mg (
OH)2 and Al(
OH)3 do not differ. The frequency of the positivity of
aluminum staining is not statistically different in the 2 groups. In 4 cases, adynamic
bone disease without
aluminum or
iron intoxications is found, associated with a relative
hypoparathyroidism. It is not explained by previous
parathyroidectomy, diabetes or
steroid therapy.
CONCLUSIONS: