Aluminum induced bone disease: Clinical features

  • Donald J. Sherrard
Part of the Developments in Nephrology book series (DINE, volume 26)


In this review of the clinical features of aluminum-induced bone disease, I will discuss several aspects of this clinical problem. I will initially describe which patients are at risk for developing this problem; next I will review the various ways this problem may present, and finally, I will clarify the confusion that often exists between the diagnosis of aluminum toxicity and that of hyperparathyroidism in patients with renal failure.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ward MK, Feest TG, Ellis HA, et al., 1978: Osteomalacic dialysis dystrophy: evidence for a water-borne aetiological agent, probably aluminum. Lancet 1: 841.PubMedCrossRefGoogle Scholar
  2. 2.
    Nathan E, Pedersen SE, 1980: Dialysis encephalopathy in a non-dialyzed uraemic boy treated with aluminum hydroxide orally. Acta Paediatr Scand 69: 793.PubMedCrossRefGoogle Scholar
  3. 3.
    Felsenfeld AJ, Gutman RA, Llach F, Harrelson JM, 1982: Osteomalacia in chronic renal failure: a syndrome previously reported only with maintenance dialysis. Am J Nephrol 2: 147.PubMedCrossRefGoogle Scholar
  4. 4.
    Maloney MA, Ott SM, Andress DL, Sherrard DJ, 1984: The occurrence of aluminum-iron deposition in renal osteodystrophy: A histochemical method to distinguish aluminum from iron for quantitative histomorphometry. Abstracts from the Sixth Annual Scientific Meeting of the American Society for Bone and Mineral Research, p. A45.Google Scholar
  5. 5.
    Andress DL, Maloney NA, Endres DB, Sherrard DJ, 1986: Aluminum-associated bone disease in chronic renal failure: High prevalence in a long-term dialysis population. J Bone Min Res 1: 391.CrossRefGoogle Scholar
  6. 6.
    Llach F, Felsenfeld AJ, Coleman MD, et al., 1986: The natural course of dialysis osteomala¬cia. Kidney Int 295: 74.Google Scholar
  7. 7.
    Hercz G, Norris KC, Andress DL, et al., 1987: Changes in aplastic bone disease after substitution of calcium carbonate for aluminum gels. Kidney Int (in press).Google Scholar
  8. 8.
    Vincenti F, Arnaud SB, Recker R, et al., 1984: Parathyroid and bone response of the diabetic patient to uremia. Kidney Int 25: 677.PubMedCrossRefGoogle Scholar
  9. 9.
    Andress DL, Kopp JB, Maloney NA, Coburn JW, et al., 1987: Early deposition of aluminum in bone in diabetic patients on hemodialysis. N Engl J Med 316: 292.PubMedCrossRefGoogle Scholar
  10. 10.
    Andreoli SP, Bergstein JM, Sherrard DJ, 1984: Aluminum intoxication from aluminum- containing phosphate binders in children with azotemia not undergoing dialysis. New Engl J Med 310: 1079.PubMedCrossRefGoogle Scholar
  11. 11.
    Vargas JH, Klein GL, Ament ME, et al., 1987: Metabolic bone disease associated with total parenteral nutrition: Course after reducing aluminum content in parenteral solutions (in press).Google Scholar
  12. 12.
    Ott SM, Maloney NA, Klein GL, et al., 1983: Aluminum is associated with low bone formation in patients receiving chronic parenteral nutrition. Ann Intern Med 98: 910.PubMedGoogle Scholar
  13. 13.
    Lipkin EW, Ott SM, Klein GL, 1987: Heterogeneity of bone histology in parenteral nutrition patients. Am J Clin Nutr (in press).Google Scholar
  14. 14.
    Williams JW, Vera SR, Peters TG, Luther RW, et al., 1986: Biliary excretion of aluminum in aluminum osteodystrophy with liver disease. Ann Intern Med 104: 782.PubMedGoogle Scholar
  15. 15.
    Sedman AB, Klein GL, Merritt RJ, et al., 1985: Evidence of aluminum loading in infants receiving intravenous therapy. N Engl J Med 312: 1337.PubMedCrossRefGoogle Scholar
  16. 16.
    Parkinson IS, Ward MK, Feest TG, et al., 1979: Fracturing dialysis osteodystrophy and dialysis encephalopathy. Lancet 1: 406.PubMedCrossRefGoogle Scholar
  17. 17.
    Coburn JW, Norris KC, 1986: Diagnosis of aluminum-related bone disease and treatment of aluminum toxicity with deferoxamine. Semin Nephrol 6: 12-21 (supplement).Google Scholar
  18. 18.
    Cochran M, Platts MM, Moorhead PJ, Buxton A, 1981: Spontaneous hypercalcemia in maintenance dialysis patients: An association with atypical osteomalacia and fractures. Mineral Electrolyte Metab 5: 280.Google Scholar
  19. 19.
    Sherrard DJ, Ott SM, Maloney NA, et al., 1983: Uremic osteodystrophy: Classification, cause and treatment. In: Clinical Disorders of Bone and Mineral Metabolism, Eds. Frame B, Potts JT Jr, Excerpta Medica, Amsterdam, 1983, pp. 254 - 259.Google Scholar
  20. 20.
    Norris KC, Crooks PW, Nebeker HG, et al., 1985: Clinical and laboratory features of aluminum-related bone disease: Differences between sporadic and “epidemic” forms of the syndrome. Am J Kidney Dis 5: 342.Google Scholar
  21. 21.
    Andress DL, Voigts A, Felsenfeld A, Llach F, 1983 Parathyroid hormone response to hypocalcemia in dialysis patients with osteomalacia and osteitis fibrosa. Kidney Int 24: 364.PubMedCrossRefGoogle Scholar
  22. 22.
    Andress DL, Endres DB, Maloney NA, et al., 1986: Comparison of parathyroid hormone assays with bone histomophometry in renal osteodystrophy. J Clinical Endo Metab 63: 1163.CrossRefGoogle Scholar
  23. 23.
    Sundaram M, Wolverson MK, 1982: The prevalence of skeletal surveys of patients on maintenance hemodialysis. Ann Intern Med 97: 780.PubMedGoogle Scholar
  24. 24.
    Sherrard DJ, Ott SM, Andress DL, 1985: Pseudohyperparathyroidism — Syndrome asso¬ciated with aluminum intoxication in patients with renal failure. Am J Med 79: 127.PubMedCrossRefGoogle Scholar
  25. 25.
    Griswold WR, Reznik V, Mendoza SA, et al., 1983: Accumulation of aluminum in a non-dialyzed uremic child receiving aluminum hydroxide. Petiatrics 71: 56.Google Scholar
  26. 26.
    Andress DL, Endres DB, Ott SM, Sherrard DJ, 1986: Parathyroid hormone in aluminum bone disease: A comparison of parathyroid assays. Kidney Int 29S: 87.Google Scholar
  27. 27.
    Martin KJ, Hruska, Freitag J, et al., 1980: Clinical utility of radioimmunoassays for parathyroid hormone. Miner Electrolyte Metab 3: 283.Google Scholar
  28. 28.
    Milliner DS, Nebeker HG, Ott SM, et al., 1984: Use of deferoxamine infusion test in the diagnosis of aluminum-related osteodystrophy. Ann Intern Med 101: 775.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • Donald J. Sherrard

There are no affiliations available

Personalised recommendations