Renal Osteodystrophy: Symptoms, Diagnosis, and Outlook

Medically Reviewed By Emelia Arquilla, DO

Renal osteodystrophy is when end stage kidney disease impairs bone regrowth. This can lead to low bone density, possibly resulting in fractures. Treatment with medication or surgery may improve bone health and alleviate pain. While renal osteodystrophy indicates advanced kidney disease, treatment for both conditions can be effective at reducing health risks.

This article discusses renal osteodystrophy, including its types, symptoms, and when to contact a doctor. It also explains the causes, treatment, and outlook for renal osteodystrophy.

Types

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There are four main types of renal osteodystrophy:

  • Adynamic bone disease: Bones regenerate at a slower rate, leading to low or atypical bone growth. Low parathyroid hormone (PTH) levels can cause adynamic bone disease.
  • Osteitis fibrosa cystica: Kidney disease may cause Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source hyperparathyroidism, leading to the overproduction of PTH. This process causes bones to break down too quickly.
  • Osteomalacia: Osteomalacia occurs when bones regrow Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source weakly because of a lack of key minerals and vitamins. Impaired kidney function, known as renal insufficiency, can cause osteomalacia.
  • Mixed renal osteodystrophy: This refers to having both osteitis fibrosa and osteomalacia.

Symptoms

Symptoms of renal osteodystrophy can vary. Some people may have Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source asymptomatic renal osteodystrophy, whereby they do not experience noticeable symptoms. Others may experience obvious signs.

Renal osteodystrophy symptoms can include:

  • bone pain
  • pain when using or placing weight on the bone
  • in children, slow or impaired growth
  • bone fractures, which may also cause:
    • swelling of the affected bone
    • changes or differences in bone shape

Renal osteodystrophy may also link to atypical levels of certain vitamins and minerals. For example, someone with renal osteodystrophy may have high levels of calcium and phosphorous and/or low levels of vitamin D. Levels outside the expected ranges may lead to further symptoms, such as:

Learn more about symptoms of high calcium levels and vitamin D deficiency.

When to see a doctor

Contact your doctor for new or persistent symptoms, especially if you have an underlying condition such as kidney disease.

Call 911 if you have symptoms of a fracture or experience other severe or sudden symptoms, such as:

Causes

End stage kidney disease and its related conditions cause renal osteodystrophy.

Bone remodeling is a typical Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , expected process that happens throughout life. It helps keep bones strong by gradually breaking down old bone tissues and replacing them with new bone tissues. Typically, bone remodeling happens in a balanced ratio, controlled by hormones and nutrients, including Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

Kidney function affects hormone and nutrient levels. Changes in these levels can also impact levels of other hormones and nutrients. For example, vitamin D can also impact PTH production and function.

As a result, factors and conditions that impact the kidney and any of these hormones and nutrients will also affect bone health and remodeling. Examples include:

For example, chronic kidney disease may cause low vitamin D levels and higher PTH levels. This can cause bone breakdown to happen faster than the bone can regrow. This is known as high bone turnover.

Low vitamin D levels can make it harder for the body to absorb calcium from the blood and use it for bone remodeling. As a result, new bone tissue that does form may be atypical and weak.

Other conditions also may cause low PTH levels that lead to low bone turnover. This can make it difficult for the new bone tissues to form properly.

Diagnosis

After reviewing your symptoms and medical history, your doctor may conduct a physical exam.

Tests that may help identify renal osteodystrophy or rule out other conditions include:

  • X-rays
  • blood tests, to measure:
    • PTH levels
    • calcium levels
    • vitamin D levels
    • phosphorus levels
    • bone-specific alkaline phosphatase, used to check bone regrowth
    • certain types of collagen, which can measure bone formation

The most effective diagnostic test for renal osteodystrophy is a bone biopsy. This involves taking a sample of bone, either with a special needle or surgery. An anesthetic helps block pain. Many clinics are unable to conduct bone biopsies, however, so they are rare.

Treatment and management

Renal osteodystrophy treatment varies based on the type and underlying cause of the condition. For example, your doctor may recommend Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source different treatment for high or low bone turnover renal osteodystrophy.

Generally, treatment involves adjusting the levels of these substances:

  • PTH
  • calcium
  • vitamin D
  • phosphate

A kidney transplant may improve an underlying kidney condition causing an imbalance in bone regrowth. However, antirejection medications given after a transplant can sometimes worsen Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source bone density.

Read more about kidney transplants, including their procedure and eligibility.

High bone turnover conditions

Treatment for high bone turnover renal osteodystrophy aims to reduce the levels and impact of PTH that your body produces. This treatment may include:

  • increased calcium levels in dialysis solution
  • vitamin D supplements
  • medications, such as:
    • cinacalcet (Sensipar)
    • lanthanum (Fosrenol)
    • sevelamer (Genzyme)

In some cases, your doctor may also recommend a low phosphate diet. This can include following a vegetarian diet. Your doctor will provide you with personalized diet recommendations.

For renal osteodystrophy that does not respond well to other treatments, your doctor may recommend a parathyroidectomy. This is a surgical procedure to remove parts of the parathyroid gland.

Low bone turnover conditions

Treatment for low bone turnover renal osteodystrophy may aim to increase PTH levels or improve its action. Your doctor may recommend oral medications to lower vitamin D and calcium levels. This increases the action of the PTH.

If you receive dialysis, your medical team may reduce the calcium levels in the dialysis solution.

Other treatments

Your doctor may also recommend additional treatments depending on your condition and its underlying cause.

Sodium bicarbonate medications can reduce acidosis. Acidosis refers to body fluids being too acidic. This may contribute to or worsen osteodystrophy.

If aluminum intake causes osteomalacia, medications such as desferrioxamine (Desferal) may help remove the aluminum from the body.

Outlook

The outlook for renal osteodystrophy depends on the severity of the underlying condition and how it responds to treatment.

Complications of renal osteodystrophy can include:

Additionally, because end stage kidney disease causes renal osteodystrophy, there is a risk of death from underlying kidney disease.

It may be possible for renal osteodystrophy to improve Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source with a kidney transplant. However, not everyone may be eligible for a kidney transplant. Contact your doctor to discuss your options. Also, bone health may worsen Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source after a transplant.

Other treatments can help reduce the severity of the condition and its impacts on your life.

Contact your doctor for personal advice on your treatment and outlook.

Summary

Renal osteodystrophy is a complication of end stage kidney disease. It refers to when the bone remodeling process is impaired, leading to bone fractures or damage.

Other factors that may contribute to renal osteodystrophy include developing hyperparathyroidism or undergoing dialysis treatment.

Renal osteodystrophy may not cause noticeable symptoms, but it can cause bone pain and fractures. Treatment can include kidney transplantation or medication to improve hormone levels.

Call 911 if you experience a bone fracture. Contact your doctor for questions or personal advice about renal osteodystrophy.

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Medical Reviewer: Emelia Arquilla, DO
Last Review Date: 2023 May 24
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