Abstract
A total of 58 bone biopsies were performed in 54 patients undergoing long-term dialysis, and their renal osteodystrophy was classified on the basis of clinical and biochemical findings, bone X-ray, bone scintigram, histology and effects of PTX or DFO therapies.
Histologically, the biopsy cases were classified into osteitis fibrosa (20), mild bone disease (9), osteomalacia (6), aplastic bone disease (21), a mixed type of osteitis fibrosa and osteomalacia (1), and osteoporosis (1). On the basis of scintigrams, the cases were classified into the patterns of osteitis fibrosa (19), osteomalacia (6), aplastic bone disease (18), and non-specific lesions (9).
The accordance rate for both classifications was 100% for osteomalacia and aplastic bone disease, and 84.2% for osteitis fibrosa. Of non-specific lasions, 88.9% were mild bone disease histologically. Aluminum-associated osteopathy was observed in 46.6% of cases: histologically, 71.4% of cases were classified as aplastic bone disease, 100% as osteomalacia, 55.6% as mild bone disease, 100% as mixed type, and none as osteitis fibrasa or osteoporosis. The pain-releiving effect of PTX or DFO therapy was marked in the lumbar ragion and hip joint and slight to moderate in the knee and ankle joints, but no effect was observed in the shoulder and hand joints. DFO was not effective in aluminum-accumulation disease. The histological effects of DFO evaluated in 8 cases revealed improvement or disapperance of Al staining, decreased osteoid, and increased active formation and absorption surfaces.
Based on these results, the 58 cases were classified into: group 1) osteitis fibrosa (active vitamin D or PTX effective), 2) aluminum-associated bone disease (DFO effective), 3) amyloid-associated osteo-arthropathy, and 4) non-aluminum-associated non-amyloid-associated (no underlying etiology was found).
