Comparison of Aluminum Related with Vitamin D Related Osteomalacia by Tetracycline Based Bone Histomorphometry

  • A. M. Parfitt
  • D. Rao
  • J. Stanciu
  • A. R. Villanueva
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 208)


Previous reports of aluminum related osteomalacia (ARO) described distinctive clinical, radiographic, biochemical and therapeutic features (1–4), but few distinctive histologic features except for the presence of aluminum (5–8). According to these reports, indices of bone resorption are reduced (5–8), but this has been based either on qualitative appraisal alone (8) or on measurement without correction for the availability of mineralized bone accessible to resorption (5–7). Furthermore, the comparison has invariably been with renal osteitis fibrosa or with normal subjects, not with other forms of osteomalacia. More recently, the term low turnover osteomalacia has been introduced (9,10), but although bone turnover in ARO is lower than in renal osteitis fibrosa, it has not been demonstrated to be lower than in other forms of osteomalacia. We have developed rigorous kinetic criteria for the diagnosis of classical osteomalacia due to vitamin D depletion (11–13); we now apply these criteria to renal bone disease and for the first time directly compare the two forms of osteomalacia.


Bone Turnover Bone Formation Rate Renal Osteodystrophy Osteitis Fibrosa Aluminum Deposition 


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  1. 1.
    Alvarez-Ude F, Feest TG, Ward MK, Pierides AM, Ellis HA, Peart KM, Simpson W, Weightman D, Kerr DNS. Hemodialysis bone disease: Correlation between clinical, histologic, and other findings. Kidney International 1978; 14: 68–73.CrossRefGoogle Scholar
  2. 2.
    Hodsman AB, Sherrard DJ, Wong EGC, Brickman AS, Lee DBN, Alfrey AC, Singer FR, Norman AW, Coburn JW. Vitamin-D-resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism. Ann Intern Med 1981; 94: 629–637.Google Scholar
  3. 3.
    Ott SM, Maloney NA, Coburn JW, Alfrey AC, Sherrard DJ. The prevalence of bone aluminum deposition in renal osteodystrophy and its relation to the response to calcitriol therapy. N Engl J Med 1982; 307: 709–713.CrossRefGoogle Scholar
  4. 4.
    Wills MR, Savory J. Aluminium poisoning:dialysis encephalopathy, osteomalacia, and anaemia. Lancet 1983;ii:29–34.CrossRefGoogle Scholar
  5. 5.
    Cournot-Witmer G, Zingraff J, Plachot JJ, Escaig F, Lefeevre R, Boumati P, Bourdeau A, Garabedian M, Galle P, Bourdon R, Drüke, Balsan S. Aluminum localization in bone from hemodialyzed patients: Relationship to matrix mineralization. Kidney International 1981; 20: 375–385.CrossRefGoogle Scholar
  6. 6.
    Hodsman AB, Sherrard DJ, Alfrey AC, Ott S, Brickman AS, Miller NL, Maloney NA, Coburn JW. Bone aluminum and histomorphometric features of renal osteodystrophy. J Clin Endocrinol Metab 1982; 54: 539–546.CrossRefGoogle Scholar
  7. 7.
    Boyce BF, Fell GS, Elder HY, Junor BJ, Elliot HL, Beastall G, Fogelman I, Boyle IT. Hypercalcaemic osteomalacia due to aluminium toxicity. Lancet 1982;ii:1009–1013.CrossRefGoogle Scholar
  8. 8.
    Ellis HA. Aluminum induced osteomalacia in patients with chronic renal failure and in animals. Nieren-und Hochdruckkrankheiten 1983; 12: S198–206.Google Scholar
  9. 9.
    Faugere MC, Abreo K, Smith A, Malluche HH. Bone aluminum accumulation: Etiology, prevalence and its influence on vitamin D therapy in patients with mild to advanced renal failure. In: Cohn DV, Potts JT Jr, Fujita T, eds. Endocrine control of bone and calcium metabolism, Vol. 8B. Elsevier Science Publishers B.V., 1984: 151–152.Google Scholar
  10. 10.
    Malluche HH, Smith AJ, Abreo K, Faugere M-C. The use of deferoxamine in the management of aluminum accumulation in bone in patients with renal failure. N Engl J Med 1984; 311: 140–144.CrossRefGoogle Scholar
  11. 11.
    Rao DS, Villanueva A, Mathews M, Pumo B, Frame B, Kleerekoper M, Parfitt AM. Histologic evolution of vitamin D depletion in patients with intestinal malabsorption or dietary deficiency. In: Frame B, Potts JT Jr, eds. Clinical Disorders of Bone and Mineral Metabolism. Amsterdam, Excerpta Medica, 1983: 224–226.Google Scholar
  12. 12.
    Parfitt AM. The cellular mechanisms of osteoid accumulation in metabolic bone disease. In: Mineral Metabolism Research in Italy, Vol. 4. Milano, Wichtig Editore, 1984: 3–9.Google Scholar
  13. 13.
    Parfitt AM, Pødenphant J, Villanueva AR, Frame B. Metabolic bone disease with and without osteomalacia after intestinal bypass surgery: A bone histomorphometric study. Bone 1985; 6: 211–220.CrossRefGoogle Scholar
  14. 14.
    Rao DS. Practical approach to bone biopsy. In: Bone Histomorphometry. Techniques and Interpretations. Recker R, ed. CRC Press, Boca Raton, FL, 1983: 3–11.Google Scholar
  15. 15.
    Maloney NA, Ott SM, Alfrey AC, Miller NL, Coburn JW, Sherrard DJ. Histological quantitation of aluminum in iliac bone from patients with renal failure. J Lab Clin Med 1982; 99: 206–216.Google Scholar
  16. 16.
    Parfitt AM. The physiologic and clinical significance of bone histomorphometric data. In: Recker R, ed. Bone Histomorphometry. Techniques and Interpretations. Boca Raton, CRC Press, 1983: 143–223.Google Scholar
  17. 17.
    Hodsman AB, Anderson C, Leung FY. Accelerated accumulation of aluminum by osteoid matrix in vitamin D deficiency. Mineral Electrolyte Metab 1984; 10: 309–315.Google Scholar
  18. 18.
    Quarles DL, Dennis VW, Gitelman HJ, Harrelson JM, Drezner MK. Aluminum deposition at the osteoid-bone interface: An epiphenomenon of the osteomalacic state in vitamin D deficient dogs. J Clin Invest 1985; 75: 1441–1447.CrossRefGoogle Scholar
  19. 19.
    Pødenphant J, Salem N, Sypitkowski C, Frame B, Parfitt AM. Reversal of aluminum related dialysis osteomalacia after transplantation. Proc Fourth International Workshop on Bone Histomorphometry. BONE (in press).Google Scholar
  20. 20.
    Boyce BF, Smith L, Fogelman I, Johnston E, Ralston S, Boyle IT. Focal osteomalacia due to low-dose diphosphonate therapy in Paget’s disease. Lancet 1984; 1: 821–824.CrossRefGoogle Scholar
  21. 21.
    Andress D, Felsenfeld AJ, Voigts A, Llach F. Parathyroid hormone response to hypocalcemia in hemodialysis patients with osteomalacia. Kidney International 1983; 24: 364–370.CrossRefGoogle Scholar
  22. 22.
    Malluche HH, Ritz E, Lange HP, Kutschera J, Hodgson M, Seiffert U, Schoeppe W. Bone histology in incipient and advanced renal failure. Kidney International 1976; 9: 355–362.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • A. M. Parfitt
    • 1
  • D. Rao
    • 1
  • J. Stanciu
    • 1
  • A. R. Villanueva
    • 1
  1. 1.Bone and Mineral Research LaboratoryHenry Ford HospitalDetroitUSA

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