The widespread clinical use of
hemodialysis has prolonged the survival of a vast number of uremic patients, but it has also yielded some problems including
renal osteodystrophy. Recently, it has become well known that the clinical use of active
vitamin D metabolites is effective in many patients with
renal osteodystrophy. However, there are many patients with
bone diseases resistant to such treatment. Several lines of evidences implicate
aluminum as one of the causal factors in the production of such diseases. We recently found 20 patients with
bone diseases associated with the deposition of
aluminum in front of active calcification in the bone. All of them were undergoing maintenance
hemodialysis with softened water thrice weekly and taking
aluminum containing
antacids and 1 alpha-(OH)D3. The age of the patients ranged between 30 y.o. and 62 y.o. (46.5 +/- 9.0, mean +/- s.d.). All of them had severe bone
pain and 8 of them had
bone fractures. Bone X-ray, bone scintigraphy, serum Ca, P, ALP, serum
aluminum and bone histology were examined. Based on the bone histology, they were classified into four types; inactive type (9),
osteomalacia type (6), mild type (4) and mixed type (1). There were no significant differences among each group concerning serum values of Ca, P and
aluminum. Serum value of ALP tended to be high in the
osteomalacia type, and that of c-PTH was significantly low in the inactive type compared with the other types. Our finding suggest that
aluminum associated
bone disease is not so rare in Japan and show that the diagnosis of this disease should be made histologically and that clinical and blood chemical features are not reliable for the diagnosis of
aluminum associated
bone disease in
hemodialysis patients.