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Effects of treatment of renal osteodystrophy on bone histology.
Clin J Am Soc Nephrol. 2008 Nov; 3 Suppl 3:S157-63.CJ

Abstract

Renal osteodystrophy is characterized by abnormalities in bone turnover, mineralization, and bone volume. The effects of treatment modalities for renal osteodystrophy on bone should be analyzed with respect to these abnormalities. The major treatment modalities for renal osteodystrophy include phosphate binders, vitamin D compounds, and calcimimetics. Aluminum-containing phosphate binders have been shown to be toxic to bone secondary to their effects on bone turnover, mineralization, and bone volume. The use of calcium-based phosphate binders has been associated with the development of adynamic bone disease (low bone turnover), bone loss, and worsening of vascular calcifications. New nonaluminum, noncalcium phosphate binders have been developed (sevelamer hydrochloride and lanthanum carbonate). These agents show a potential for improvement in bone turnover and bone volume. Patients with renal osteodystrophy are deficient in calcitriol and often in calcidiol. Calcidiol deficiency has been underappreciated and deserves to be addressed in the treatment of patients with renal osteodystrophy. Calcitriol replacement therapy by daily oral administration is associated with frequent episodes of hypercalcemia and suppression of bone turnover in patients with stages 3 to 5 chronic kidney disease. Pulse oral or intravenous calcitriol administration induces frequent episodes of hypercalcemia or hyperphosphatemia, respectively, and achieves the same degree of correction of bone abnormalities. There are no data on the effects of paricalcitol or doxercalciferol on human bone. Experimental data, however, show that these two analogues and maxacalcitol may control serum parathyroid hormone levels without suppressing bone turnover. Calcimimetics lower parathyroid hormone levels and bone turnover.

Authors+Show Affiliations

Division of Nephrology, Bone & Mineral Metabolism, University of Kentucky, Lexington, KY 40536-0084, USA. hhmall@uky.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18988701

Citation

Malluche, Hartmut H., et al. "Effects of Treatment of Renal Osteodystrophy On Bone Histology." Clinical Journal of the American Society of Nephrology : CJASN, vol. 3 Suppl 3, 2008, pp. S157-63.
Malluche HH, Mawad H, Monier-Faugere MC. Effects of treatment of renal osteodystrophy on bone histology. Clin J Am Soc Nephrol. 2008;3 Suppl 3:S157-63.
Malluche, H. H., Mawad, H., & Monier-Faugere, M. C. (2008). Effects of treatment of renal osteodystrophy on bone histology. Clinical Journal of the American Society of Nephrology : CJASN, 3 Suppl 3, S157-63. https://doi.org/10.2215/CJN.02500607
Malluche HH, Mawad H, Monier-Faugere MC. Effects of Treatment of Renal Osteodystrophy On Bone Histology. Clin J Am Soc Nephrol. 2008;3 Suppl 3:S157-63. PubMed PMID: 18988701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of treatment of renal osteodystrophy on bone histology. AU - Malluche,Hartmut H, AU - Mawad,Hanna, AU - Monier-Faugere,Marie-Claude, PY - 2008/11/15/pubmed PY - 2009/1/14/medline PY - 2008/11/15/entrez SP - S157 EP - 63 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 3 Suppl 3 N2 - Renal osteodystrophy is characterized by abnormalities in bone turnover, mineralization, and bone volume. The effects of treatment modalities for renal osteodystrophy on bone should be analyzed with respect to these abnormalities. The major treatment modalities for renal osteodystrophy include phosphate binders, vitamin D compounds, and calcimimetics. Aluminum-containing phosphate binders have been shown to be toxic to bone secondary to their effects on bone turnover, mineralization, and bone volume. The use of calcium-based phosphate binders has been associated with the development of adynamic bone disease (low bone turnover), bone loss, and worsening of vascular calcifications. New nonaluminum, noncalcium phosphate binders have been developed (sevelamer hydrochloride and lanthanum carbonate). These agents show a potential for improvement in bone turnover and bone volume. Patients with renal osteodystrophy are deficient in calcitriol and often in calcidiol. Calcidiol deficiency has been underappreciated and deserves to be addressed in the treatment of patients with renal osteodystrophy. Calcitriol replacement therapy by daily oral administration is associated with frequent episodes of hypercalcemia and suppression of bone turnover in patients with stages 3 to 5 chronic kidney disease. Pulse oral or intravenous calcitriol administration induces frequent episodes of hypercalcemia or hyperphosphatemia, respectively, and achieves the same degree of correction of bone abnormalities. There are no data on the effects of paricalcitol or doxercalciferol on human bone. Experimental data, however, show that these two analogues and maxacalcitol may control serum parathyroid hormone levels without suppressing bone turnover. Calcimimetics lower parathyroid hormone levels and bone turnover. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/18988701/Effects_of_treatment_of_renal_osteodystrophy_on_bone_histology_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=18988701 DB - PRIME DP - Unbound Medicine ER -