Osteodystrophy is a medical term used to describe abnormal changes in the growth and formation of bone.
It is most commonly the result ofchronic kidney disease.
Because the disease is the result of the malabsorption ofcalcium, osteodystrophy is most commonly treated with calcium supplements.
Osteodystrophy doesn’t manifest in the same way in everyone.
A less common cause of osteodystrophy is severe primaryhyperparathyroidism(overactive parathyroid glands).
The parathyroid glands help regulate calcium levels by releasing hormones into the blood.
The disease in children is very different from that in adults.
In early disease, there may be no notable signs or symptoms.
It is only when bone turnover and/or mineralization are significantly impaired that the cumulative effect becomes more apparent.
Osteodystrophy in children is arguably more profound, since it can lead to short stature and bone deformity.
One example is the inward bowing of the legs, referred to as “renal rickets.”
Symptoms like these can develop in children well beforedialysisis needed.
Complications
As a facet of CKD-MBD, osteodystrophy can co-occur withcardiovascular disease.
Adults with osteodystrophy are also vulnerable toavascular necrosis(a.k.a.
This pops up if tiny breaks in a bone cause it to collapse and cut off blood circulation.
Causes
The pathogenesis (manner of development) of osteodystrophy is complex.
When the kidneys are damaged, they are less able to filter waste from the blood.
Osteodystrophy is common in people with end-stage renal failure, affecting around 90% of adults and children onhemodialysis.
Primary vs. ## Risk Factors
Renal osteodystrophy is the result of CKD and the onset of acute kidney failure.
In the end, if your kidneys start to fail, you are at risk of osteodystrophy.
Physical Examination
Osteodystrophy is often recognized in adults when a fracture occurs with advancing CKD.
A history of bone and joint pain are also common complaints.
The findings can differ significantly in children.
Elevations of FGF-23 are indicative of the progression of kidney disease.
The stage of osteodystrophy can often be suggested by the results of these blood tests.
With the onset of symptomatic disease, calcium and calcitriol levels will plummet as PTH and phosphorus levels rise.
Imaging Studies
StandardX-raysorcomputed tomography (CT) scansare typically used in the diagnosis of osteodystrophy.
Stains are important to the process.
People with advanced CKD often have excessive amounts of aluminum and iron in their bodies.
With osteodystrophy, these minerals will be found in high concentrations in bone and confirmed with special reactive stains.
Another test, called double tetracycline labeling, can detect abnormalities in bone turnover.
It involves the consumption of oral tetracycline, anantibiotic.
This binds to the newly formed bone.
The exclusion of these conditions can help support the diagnosis.
The differential diagnosis of renal osteodystrophy varies depending on the sites of involvement.
Given that renal osteodystrophy most often occurs in people with kidney failure, hemodialysis is typically involved.
Lifestyle
Renal osteodystrophy requires a lifestyle change to prevent further bone loss and damage.
This includes the restriction of dietary phosphorus, especially inorganicphosphatesfound in food additives.
Over-the-Counter Therapies
Calciumandvitamin D supplementsare also sometimes prescribed in people with hyperparathyroidism.
Your healthcare provider may also recommend over-the-counter phosphate binders.
These work by binding to phosphorus in the bloodstream and increasing its excretion from the body.
The drug works by imitating calcium, and, by doing so, lowers PTH levels in the blood.
Taken twice daily by mouth, Sensipar can cause nausea, diarrhea, and vomiting in some people.
The drugs may be taken anywhere from once-daily to thrice-weekly and are not known to cause notable side effects.
There is also an injectable form of calcitriol called Calcijex.
Depending on the person’s age and general health, a parathyroidectomy may be performed as eitherinpatient or outpatientsurgery.
Parathyroidectomies are minimally invasive, requiring a 2.5-centimeter (roughly 1-inch) incision.
Recovery generally takes between one and two weeks.
Akidney transplantis also an option if other treatments fail.
It requires patience on your part to ensure the correct diagnosis and the appropriate treatment.
This includes being adherent to your diet regimen, exercising appropriately, and taking your medications as prescribed.
If you suspect your child has osteodystrophy, ask your healthcare provider to investigate.
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