[The skeletal resistance to PTH and osteoprotegerin].
The skeletal resistance to PTH is a phenomenon specifically found in uremia which is considered to be a back ground abnormality associated with the development of renal bone diseases. The skeletal resistance to PTH appears as an anti-calcemic effect against exogenous PTH load in the physiological aspect, and as the discrepancy between serum PTH level and bone turnover in the morphological aspect. Therefore, it can be a common pathogenesis of both secondary hyperparathyroidism and adynamic bone. The break through in osteoclastology largely attributed to understand the pathophysiology of the skeletal resistance. As a result, circulating osteoprotegerin appeared to be one of the factors to promote the skeletal resistance to PTH in uremia through suppressing osteoclastogenesis/activation. However, the mechanism why circulating osteoprotegerin level is elevated remains unknown. Further investigations are certainly needed.
Kazama
Junichiro James
JJ
Division of Nephrology and Clitical Care Medicine, Niigata University Medical Hospital.