Clinical and Laboratory Features of Aluminum-Related Bone Disease: Differences Between Sporadic and “Epidemic” Forms of the Syndrome

R EPORTS from the United Kingdom first described a constellation of musculoskeletal signs and symptoms in as many as 30% of dialysis patients from certain geographic areas with water aluminum levels above 75 to 100 j-tg/L1-3; the clinical features included bone pain, myopathy, multiple fractures, and encephalopathy. Bone biopsies demonstrated osteomalacia. Biochemical parameters included a tendency toward hypercalcemia, normal or only mildly elevated alkaline phosphatase levels, normal or lower than predicted serum iPTH levels, and a microcytic anemia. In the United States, such patients were uncommon, and the prevalence of vitamin D-resistant osteomalacia in patients from several dialysis units was estimated at I % to 3 % .4 Aluminum-related bone disease can also occur from the intestinal absorption of aluminum from the phosphate binders taken by these patients; this may be the most prevalent cause in the United States. 4·6 We describe the clinical and biochemical features of 40 dialysis patients with biopsy-proven and symptomatic aluminum-related bone disease, most from dialysis units using adequately treated water. In contrast to other patients with comparable durations of dialysis (asymptomatic patients and those with osteitis fibrosa), the features of