Summary
Many hemodialysis patients undergo subtotal parathyroidectomy (sPTx) because of the complications of severe secondary hyperparathyroidism. In some patients, however, renal osteodystrophy fails to regress. In uremia, the high levels of circulating immunoreactive parathyroid hormone (iPTH) which accompany osteitis fibrosa are associated with accelerated bone formation. After sPTx, the fall in iPTH may decrease mineralization and increase osteoid formation. Bone histomorphometry, densitometry, and serum biochemical determinations were done in 20 patients on regular maintenance hemodialysis and after sPTx in 3 additional patients. Densitometry at the radial diaphysis was inversely related to osteoid volume so that low bone mineral content indicated excess osteoid. Elevated serum alkaline phosphatase activity was associated with osteitis fibrosa. Tetracycline double labels identified 5 patients with an increased rate of mineralization. Levels of iPTH and serum phosphorus were positively correlated to the mineralization rate. The fall in iPTH after sPTx was accompanied by a reduction in osteitis fibrosa and decreased mineralization. The nonosteoblastic osteoid became more abundant. After sPTx some hemodialysis patients may convert the osteitis fibrosa to a poorly treatable low turnover osteomalacia.
Similar content being viewed by others
References
Parfitt, A. M., Massry, S. G., Winfield, A. C.: Osteopenia and fractures occurring during maintenance hemodialysis, Clin. Orthop. Rel. Res.87:287–302, 1971
Sherrard, D. J., Baylink, D. J., Wergedal, J. E., Maloney, N. A.: Quantitative histological studies on the pathogenesis of uremic bone disease, J. Clin. Endocrinol. Metab.39:119–135, 1974
Teitelbaum, S. L., Bergfield, M. A., Freitag, J., Hruska, K.: Accelerated bone formation in end stage renal disease. In A. W. Normal, K. Schaefer, Dv. Herrath, H.-G. Grigoleit, J. W. Coburn, H. F. DeLuca, E. B. Mawer, T. Suda (eds.): Vitamin D, Basic Research and Its Clinical Application, pp. 373–380. Walter de Gruyter, Berlin, 1979
Teitelbaum, S. L., Bergfield, M. A., Freitag, J., Hruska, K. A., Slatopolsky, E.: Do parathyroid hormone and 1,25 dihydroxyvitamin D modulate bone formation in uremia?, J. Clin. Endocrinol. Metab.51:247–251, 1980
Weinstein, R. S., Whyte, M. P.: Heterogeneity of adult hypophosphatasia, Arch. Intern. Med.,141:727–731, 1981
Merz, W. H., Schenk, R. K.: Quantitative structural analysis of human cancellous bone, Acta Anat. (Basel)75:54–66, 1970
Schenk, R. K.: Standard values (histomorphometric)—iliac crest cancellous bone. In Z. F. G. Jaworski (ed.): Proceedings of the First Workshop on Bone Morphometry, pp. 392–394. University of Ottawa Press, Ottawa, 1976
Melsen, F., Mosekilde, L.: Tetracycline double labelling of iliac trabecular bone in 41 normal adults, Calcif. Tissue Res.26:99–102, 1978
Frost, H. M.: A method of analysis of trabecular bone dynamics. In P. J. Meunier (ed.): Bone Histomorphometry—Second International Workshop, pp. 445–476. Société de la Nouvelle Imprimerie Fournie, Toulouse, France, 1977
Cameron, J. R., Sorenson, J. A.: Measurement of bone mineral in vivo. An improved method, Science142:230–232, 1963
Mazess, R. B., Cameron, J. R.: Bone mineral content in normal U.S. Whites. In R. B. Mazess (ed.): International Conference on Bone Mineral Measurement, pp. 228–238. U.S. Dept. of Health, Education and Welfare, NIH-75-683, Washington, D.C., 1975
Mayor, G. H., Sanchez, T. V., Garn, S. M.: Adjusting photon-absorptiometry norms for Whites to the Black subject. In R. B. Mazess (ed.): Proceedings—Fourth International Conference on Bone Mineral Measurement, pp. 99–106. U.S. Dept. of Health and Human Services, NIH-80-1938, Washington, D.C., 1980
Arnaud, C. D., Tsao, H. S., Littledike, T.: Radioimmunoassay of human parathyroid hormone in serum, J. Clin. Invest.50:21–34, 1971
Colton, T.: Statistics In Medicine, pp. 219–227. Little, Brown and Co., Boston, 1974
Malluche, H. H., Ritz, E., Lange, H. P., Kutschera, J., Hodgson, M., Seiffert, U., Schoeppe, W.: Bone histology in incipient and advanced renal failure, Kidney Int.9:355–362, 1976
Teitelbaum, S. L.: Metabolic and other nontumorous disorders of bone. In W. A. D. Anderson, J. M. Kissane (eds.): Pathology, 7th Ed., p. 1944. C.V. Mosby Co., St. Louis, 1977
Woods, C. G., Morgan, D. B., Paterson, C. R., Gossman, H. H.: Measurement of osteoid in bone biopsy, J. Pathol. Bacteriol.95:441–447, 1968
Teitelbaum, S. L., Bullough, P. G.: The pathophysiology of bone and joint disease, Am. J. Pathol.96:283–354, 1979
Hruska, K. A., Teitelbaum, S. L., Kopelman, R., Richardson, C. A., Miller, P., Debman, J., Martin, K., Slatopolsky, E.: The predictability of the histological features of uremic bone disease by non-invasive techniques, Metab. Bone Dis. Rel. Res.1:39–44, 1978
Duursma, S. A., Visser, W. J., Dorkout-Mees, E. J., Nijo, L.: Serum calcium, phosphate, and alkaline phosphatase and morphometric bone examinations in 30 patients with renal insufficiency, Calcif. Tissue Res.16:129–138, 1974
Teitelbaum, S. L., Russell, J. E., Bone J. M., Gilden, J. J., Avioli, L. V.: The relationship of biochemical and histomorphometric determinations of uremic bone, Arch. Pathol. Lab. Med.103:228–230, 1979
Frazer, D. R., Kodicek, E.: Unique biosynthesis by kidney of a biologically active vitamin D metabolite, Nature228:764–766, 1970
Ward, M. K., Parkinson, I. S., Feest, T. G., Ellis, H. A., Kerr, D. N. S.: Newcastle bone disease. In A. W. Norman, K. Schaefer, Dv. Herrath, H.-G. Grigoleit, J. W. Coburn, H. F. DeLuca, E. B. Mawer, T. Suda (eds.): Vitamin D, Basic Research and Its Clinical Application, pp. 835–838. Walter de Gruyter, Berlin, 1979
Ahmed, K. Y., Wills, M. R., Skinner, R. K., Varghese, Z., Meinhard, E., Baillod, R. A.: Persistent hypophosphatemia and osteomalacia in dialysis patients not on oral phosphatebinders: response to dihydrotachysterol therapy, Lancet2:439–442, 1976
Hodsman, A. B., Sherrard, D. J., Wong, E. G. C., Buckman, A. S., Lee, D. B. N., Alfrey, A. C., Singer, F. R., Coburn, J. W.: Vitamin D-resistant osteomalacia without secondary hyperparathyroidism in dialysis patients, Clin. Res. 28:560A, 1980 (abst.)
Malluche, H. H., Sherman, D., Goldstein, D. A., Massry, S. G.: Role of parathyroid hormone (PTH) in bone mineralization, presented at the Seventh International Conference on Calcium Regulating Hormones, Estes Park, Colorado, September, 1980
David, D. S.: Mineral and bone homeostasis in renal failure: pathophysiology and management. In D. S. David (ed.): Calcium Metabolism in Renal Failure and Nephrolithiasis, pp. 61–76. John Wiley & Sons, New York, 1977
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Weinstein, R.S. Decreased mineralization in hemodialysis patients after subtotal parathyroidectomy. Calcif Tissue Int 34, 16–20 (1982). https://doi.org/10.1007/BF02411202
Issue Date:
DOI: https://doi.org/10.1007/BF02411202