Adynamic bone and chronic renal failure: An overview

Renal osteodystrophy may present with a wide spectrum of bone lesions, rang ing from high bone turnover to low bone turnover. Decreased serum calcium a nd 1,25-dihydroxy Vitamin D synthesis and retention of phosphate are involv ed in the pathogenesis of high bone turnover. However, several factors may influence the evolution of this disorder. The use of different therapeutic approaches (such as calcium supplements, phosphate binders, vitamin D metab olites, etc.), the type of treatment (either hemodialysis or continuous amb ulatory peritoneal dialysis), and also the changes in the type of patients to whom we are offering dialysis (more diabetics and older patients are cur rently included in dialysis programs) may have introduced changes modifying the form of presentation of the bone metabolic disorders. As a result, rec ent studies reported a greater prevalence of adynamic forms of renal osteod ystrophy. Patients with adynamic bone (with or without aluminum) would have more difficulties in handling and buffering calcium loads; consequently, t hey would have a higher risk of extraosseous calcifications.