Reversal of aluminum-related bone disease after substituting calcium carbonate for aluminum hydroxide.
Aluminum-related osteodystrophy, a crippling disease in patients with renal failure, can develop from the long-term ingestion of aluminum hydroxide gels. We present a diabetic patient treated with continuous ambulatory peritoneal dialysis (CAPD) who developed markedly elevated plasma aluminum levels but no musculoskeletal symptoms. Bone biopsy revealed features of the aplastic form of aluminum-related disease with significant aluminum staining, decreased osteoblastic osteoid, and decreased bone formation by double tetracycline labeling, but no excess accumulation of unmineralized osteoid. Aluminum hydroxide gels were discontinued and the patient received calcium carbonate to control hyperphosphatemia; 9 months later, a bone biopsy showed marked improvement of the aluminum-related bone disease, and at 2 to 10 months, plasma aluminum had decreased from 208.7 +/- 10.3 (SE) to 55.7 +/- 3.9 micrograms/L.
Hercz
G
G
Medical Service, VA Wadsworth Medical Center, Los Angeles, CA 90073.
Andress
D L
DL
Nebeker
H G
HG
Shinaberger
J H
JH
Sherrard
D J
DJ
Coburn
J W
JW
D000368:Aged; D000535:Aluminum / Q000009:adverse effects*; D000536:Aluminum Hydroxide / Q000009:adverse effects*; D001706:Biopsy; D001842:Bone and Bones / Q000473:pathology; D002119:Calcium Carbonate / Q000627:therapeutic use*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory
D000536:Aluminum Hydroxide; D000535:Aluminum; D002119:Calcium Carbonate