Renal osteodystrophy prevention

Vitamin D analog of choice for prevention and treatment of renal osteodystrophy less expensive than calcitriol... 

Alfacalcidol and calcitriol have some advantages over calciferol, but their high potency involves a risk of hypercalcemia even after small dosage increments, because of increased intestinal calcium absorption. Because of this, constant vigilance is required to prevent hypercalcemia, especially in patients with chronic renal insufficiency and associated renal osteodystrophy. 

Intermediate concentrations are seen in low-turnover adynamic (aplastic) disease and early osteitis fibrosa. Considerable overlap in intact PTH concentrations is apparent among the various forms of renal osteodystrophy. In dialysis patients, cut-points ( decision levels ) of less than 100 or 150 pg/mL and greater than 250 to 300 pg/mL have been suggested for distinguishing patients with low-turnover and high-turnover bone disease, respectively. A reasonable therapeutic goal for intact PTH (first generation) concentrations is two to four times the upper limit of the reference interval to prevent parathyroid-suppressed, adynamic, and hyperparathyroid bone diseases. ... 

Klaus G, Watson A, Edefonti A et al (2006) Prevention and treatment of renal osteodystrophy in children on chronic renal failure European guidelines. Pediatr Nephrol 21 151-159... 

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. 

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