Comparison of Aluminum Related with Vitamin D Related Osteomalacia by Tetracycline Based Bone Histomorphometry
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.
KeywordsBone Turnover Bone Formation Rate Renal Osteodystrophy Osteitis Fibrosa Aluminum Deposition
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