DR ZAMIN PPT (1).pptx

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Dr Zamin Abbas

Metabolic bone disease

Health & Medicine

RENAL OSTEODYSTROPHY
DR ZAMIN ABBAS
RESIDENT ORTHOPAEDICS SURGEON

• Form of metabolic bone disease
• seen in patients with chronic renal insufficiency
• characterized by bone mineralization deficiency due to electrolyte
and endocrine abnormalities.

Pathophysiology
• hypocalcemia
• hyperparathyroidism and secondary hyperphosphatemia
• uremia related phosphate retention

$Associated conditions • osteomalacia (adults) and growth retardation (children) • AVN • tendinitis and tendon rupture • carpal tunnel syndrome • pathologic fracture$

High-turnover renal bone disease (high PTH
disease)
• chronically elevated phosphate leads to secondary hyperparathyroidism
• lowers serum Ca, stimulating PTH
• impairs renal 1α-hydroxylase, reducing 1,25(OH)2 vitamin D3 production
• directly stimultes PTH production
• decreased calcium, increased serum phosphate, increased alkaline
phosphate, increased parathyroid hormone

Low turnover renal bone disease (normal PTH
disease)
• normal levels of PTH with characteristic bone lesions
• deposition of aluminium into bone
• impairs PTH release from parathyroid gland
• disrupts mineralization

$Presentation • weakness • bone pain • pathological fracture (commonest complication) • skeletal deformity • symptoms of hypocalcemia$

Physical exam
• Trousseau's Sign
• Chvostek's Sign

Histology
• thinned trabeculae
• amyloid stains pink on Congo red stain

Labs
• decreased serum calcium
• increased serum phos
• increased PTH

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