Article révisé par les pairs
Résumé : Bone biopsy of two dialyzed patients with fracturing osteomalacic osteodystrophy showed aluminium deposit on bone surfaces and on cemental lines. Bone metabolism was studied before and after parathyroidectomy and during the course of desferrioxamine (DFO) therapy. Before treatment, low bone calcium acretion rate, low bone uptake of (99m)Tc-pyrophosphate, hypercalcemia with minimal doses of 1 α-hydroxyvitamin D and high serum aluminum levels were observed. The patients were unresponsive to parathyroidectomy. After 1 month of DFO therapy (2 g i.v. per dialysis), the clinical status had improved dramatically. The bone calcium accretion rate had increased 5-fold and bone scintigraphy revealed a high uptake of (99m)Tc-pyrophosphate. Due to 'hungry bone' syndrome, hypocalcemia developed, and necessitated treatment with high doses of vitamin D metabolites and calcium. After 12 months of DFO therapy, the bone calcium accretion rate returned to normal and aluminum deposits on bone decreased. Bone disease in these patients was characterized by a marked impairment of calcium accumulation in bone, a defect that is rapidly reversed by DFO. The observation of the bone metabolic events during therapy was facilitated by prior parathyroidectomy.