Current Status of the Use of Newer Analogs of Vitamin D in the Management of Renal Osteodystrophy

  • Jack W. Coburn
  • Arnold S. Brickman
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 103)


In this discussion, the term renal osteodystrophy is used to denote a clinical syndrome observed in azotemic patients with a variety of skeletal lesions including osteitis fibrosa, osteomalacia, osteosclerosis, osteoporosis, and retardation of growth. The pathophysiologic alteration in advanced renal failure include hypocalcemia, hyperphosphatemia, hypermagnesemia, soft tissue calcification, and impaired intestinal calcium absorption. Secondary hyperparathyroidism is a major feature, and it is believed to have its onset early in the course of renal insufficiency. Parathyroid hyperplasia is thought to arise as a consequence of hypocalcemia produced in part by 1) phosphate retention and hyperphosphatemia, 2) from impaired renal conversion of 25-hydroxy-vitamin D3 [25(OH)D3] to 1,25-dihydroxy-vitamin D3 [1,25(OH)2D3], and 3) reduced skeletal responsiveness to the calcemic action of PTH. Knowledge that the kidney is the sole organ capable of producing 1,25(OH)2D3, the most active known form of vitamin D, from 25(OH)D3 (1) suggests a major pathogenic role of altered vitamin D metabolism in causing renal osteodystrophy. The observations that plasma levels of 1,25(OH)2D3 are low (2), the failure of conversion of radio-labeled 25(OH)D3 to 1,25(OH)2D3 (3) and the restoration of intestinal Ca absorption to normal following treatment with 1,25(OH)2D3 (4,5) in patients with end-stage uremia support the concept that renal production of 1,25(OH)2D3 is impaired in advanced renal failure. Moreover, such observations have prompted numerous clinical trials employing newer vitamin D analogs to uremic patients with bone disease. It is our purpose to briefly review the present state of knowledge on the usefulness of these analogs in renal osteodystrophy.


Chronic Renal Failure Secondary Hyperparathyroidism Alkaline Phosphatase Level Uremic Patient Renal Osteodystrophy 
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Copyright information

© Plenum Press, New York 1978

Authors and Affiliations

  • Jack W. Coburn
    • 1
    • 2
    • 3
  • Arnold S. Brickman
    • 1
    • 2
    • 3
  1. 1.Medical and Research ServicesVA Wadsworth HospitalLos AngelesUSA
  2. 2.Sepulveda VA HospitalSepulvedaUSA
  3. 3.Department of MedicineUCLA School of MedicineLos AngelesUSA

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