Aluminium-related osteodystrophy and desferrioxamine treatment: role of phosphorus.
We investigated (1) the prevalence of aluminium overload among 96 patients with symptomatic bone disease haemodialysed from 1987 to 1989 in the Sao Paulo area, Brazil; (2) the effect of 6 months desferrioxamine (DFO) treatment (1-2g/week). All patients underwent a first bone biopsy. Aluminium overload (extent of stainable bone aluminium more than 20% trabecular surface) was observed in 74 of 96 patients. Forty overloaded patients were divided into patients with high bone formation rate (BFR) (group 1; n = 17) and patients with low BFR (group 2; n = 23), and had a second biopsy after DFO therapy. In both groups aluminium surface was reduced after treatment (P < 0.001), osteoblast surface (P < 0.02-P < 0.01) and plasma parathyroid hormone (iPTH) (P < 0.01) increased. In group 1 BFR remained high. In group 2 BFR remained low in 16 patients (2a) and increased in seven (P < 0.02) (2b). In group 2a plasma phosphorus was below that in group 2b patients, before (P < 0.03) and after (P < 0.01) DFO. The histological features of group 2a patients resembled hypophosphataemic osteomalacia, those of group 2b patients aluminium osteodystrophy. These data show a high prevalence of aluminium overload in Brazilian patients. Low-dose DFO therapy was safe, decreased bone pain, prevented fractures, and reduced stainable bone aluminium. Bone lesions only partially improved, suggesting that low phosphorus intake and/or plasma calcitriol concentrations may have prevented improvement of bone formation and mineralization.
Laboratorie de Fisiopatologia Renal, Facultade de Medicina, Universidade de Sao Paulo, Brazil.
V
V
Jorgetti
N M
NM
Soeiro
V
V
Mendes
R C
RC
Pereira
M E
ME
Crivellari
G
G
Coutris
A
A
Borelli
M O
MO
Leite
I
I
Nussenzweig
M
M
Marcondes
D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000535:Aluminum / Q000032:analysis* / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium / Q000097:blood; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D003676:Deferoxamine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007085:Ilium / Q000737:chemistry / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood / Q000378:metabolism*; D006435:Renal Dialysis / Q000009:adverse effects
D010281:Parathyroid Hormone; D010758:Phosphorus; D000535:Aluminum; D000469:Alkaline Phosphatase; D003676:Deferoxamine; D002118:Calcium