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THE BIOCHEMICAL BASIS OF THE SKELETAL CHANGES IN CHRONIC UREMIA

ROBERT SHAPIRO M.D.

1. A brief review of bone mineralization and of the hormones involved in skeletal turnover is presented.

2. Also presented is a discussion of the biochemical abnormalities associated with chronic renal failure.

3. An attempt is made to correlate the biochemical abnormalities with the skeletal changes demonstrable by roentgenography. Basically, patients with chronic uremia develop a resistance to vitamin D which results in rickets or osteomalacia. The latter in turn is responsible for compensatory secondary hyperparathyroidism.

4. Fluctuations in the rickets osteomalacia and the secondary hyperparathyroidism, and predominance of one process over the other adequately explain the roentgen findings.

5. A hypothesis is offered to account for the "rugger-jersey" appearance of the spine.


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