In Japan there is a steady increase in patients who have been on dialysis
therapy for more than 10 years. Bone lesions could emerge as a serious problem during this dialysis period. From 1986 to 1993, bone lesions were examined by histomorphometry of the bone tissues (40 biopsis, 17 autopsies) in fifty seven patients who have undergone a long-term
hemodialysis treatment (37 males, 20 females) at Toranomon hospital. Mean age of the patients was 56 +/- 11 (SD) years (range; 22 to 74) and mean dialysis period, 14.5 +/- 11 (SD) years (range; 10 to 28). The results were compared with biochemical and endocrinological data. The subjects were classified into
osteitis fibrosa group (33%),
osteomalacia group (12%), mixed group (7%) and mild group (48%). Intact
parathyroid hormone (PTH) and
alkaline phosphatase (Al-P) value were significantly higher in
osteitis fibrosa and mixed groups, all cases showing intact-PTH values greater than 500 pg/ml (normal value; 20-53), but not in osteomalcia and mild groups. The analysis of 32 cases with intact-PTH higher than 500 pg/ml showed
osteitis fibrosa in 59.4% mixed in 12.5%,
osteomalacia in 3.1% and mild in 25%.
Aluminum was positive in 41% for
osteitis fibrosa, 25% for mixed, 60% for
osteomalacia and 52% for mild group. In summary, cases having undergone
hemodialysis more than 10 years showed higher frequency of
osteitis fibrosa when intact-PTH exceeded 500 pg/ml. Al-P values in such cases were high in association with the intact-PTH values. There was no significant correlation between
aluminum deposition and respective bone tissue types.