Vitamin-D-resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism.

Abstract:

:We describe a sporadic, vitamin-D-resistant osteomalacic syndrome in 19 patients undergoing hemodialysis. The syndrome was found in less than 1.5% of patients from referring dialysis centers. All 19 patients had multiple fractures, severe myopathy, and many developed spontaneous hypercalcemia. Severe osteomalacia without evidence of secondary hyperparathyroidism distinguished this syndrome from other forms of renal osteodystrophy. Bone aluminum, measured in six patients, was greatly elevated. Therapy with calcitriol (1 alpha, 25-dihydroxycholecalciferol) lad to clinical improvement in seven patients with reduced pain and myopathy, decreased serum alkaline phosphatase, or both, but no improvement in bone histology. Patients who did not respond clinically to calcitriol developed marked hypercalcemia. The cause of this severe osteomalacia, which occurs despite normal or slightly elevated levels of serum calcium and phosphorus and fails to mineralize with calcitriol, is unclear.

journal_name

Ann Intern Med

authors

Hodsman AB,Sherrard DJ,Wong EG,Brickman AS,Lee DB,Alfrey AC,Singer FR,Norman AW,Coburn JW

doi

10.7326/0003-4819-94-5-629

subject

Has Abstract

pub_date

1981-05-01 00:00:00

pages

629-37

issue

5

eissn

0003-4819

issn

1539-3704

journal_volume

94

pub_type

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