Bone disease, aluminium related

Aluminium is the third most abundant element on earth but it is known to have toxic effects that cause brain disease, bone disease, and anaemia. There is concern especially in relation to its possible role in Alzheimer s disease. The changes observed in animals exposed to aluminium are similar to those observed in patients with Alzheimer s disease. Aluminium has been found in some areas of the brain of victims of Alzheimer s at levels not too dissimilar from that in the brains of the animals exposed. Some of the findings and their interpretation are controversial. Unfortunately, the amounts of aluminium absorbed by the residents of Camelford are... 

Unexpected persistent aluminium-related bone disease occurred after renal transplantation following earlier use of aluminium hydroxide (62). 

A 59-year-old man presented with end-stage renal insufficiency. While on hemodialysis he had used aluminium hydroxide as a phosphate binder but then used calcium lactate instead after total parathyroidectomy. Oral vitamin D was discontinued after the parathyroidectomy. However, after he had received a renal transplant he developed aluminium-related bone disease and was treated with infusions of deferoxamine. 

This is the first report of worsening aluminium-related bone disease after renal transplantation. 

Hyperparathyroidism and aluminium hydroxide lead to aluminium-related bone disease however, total parathyroidectomy does not lead to failure of aluminium mobilization after renal transplantation. This man had satisfactory graft function, and the aluminium excretion that was achieved by deferoxamine suggests that the renal transplant was not the limiting factor for the mobihzation of aluminium. The most likely explanation was that he developed adynamic bone through a combination of vitamin D deficiency, hypoparathyroidism, and aluminium deposition. Vitamin D supplementation failed to prevent the osteodystrophy on its own. When aluminium chelation therapy was used, bone healing occurred and his symptoms improved. 

Nicholas JC, Dawes PT, Davies SJ, Freemont AJ. Persisting aluminium-related bone disease after cadaveric renal transplantation. Nephrol Dial Transplant 1999 14(l) 202-4. 

Yaqoob M, Ahmad R, Roberts N, Helliwell T. Low-dose desferrioxamine test for the diagnosis of aluminium-related bone disease in patients on regular haemodialysis. Nephrol Dial Transplant 1991 6(7) 484-6. 

Treatments of diseases such as osteoporosis, rickets and osteomalacia, in which there is a disturbance of phosphate levels, is complicated by the interdependence of calcium metabolism. This topic has recently been discussed in relation to clinical medicine21. There is the further difficulty that absorption of phosphate from the bowel can be decreased in the presence of calcium or aluminium salts because of the formation of their insoluble phosphates. Uptake of phosphate by bone is exploited in the treatment of polycythaemia vera by intravenous injection of 32P as sodium phosphate. The resulting irradiation of the neighbouring red bone marrow diminishes the production of red cells. 

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