The clinical, biochemical, radiological and histological appearances of the bones of 38 patients with advanced renal failure are presented. Thirty-three patients had histological evidence of hyperparathyroidism and 17 also showed osteomalacia. Of five showing evidence of neither hyperparathyroidism nor osteomalacia, two had borderline osteopenia. There was an inverse correlation between the plasma calcium concentration and trabecular surface covered by osteoid with a tendency for those with the lowest concentrations of plasma calcium to show histological osteomalacia. There was an inverse correlation between extent of calcification front and both volume and surface extent of osteoid. No relation was found between plasma phosphorus concentration and any of the histological measurements made. Patients with radiological hyperparathyroidism had a lower calcium and higher plasma phosphorus than those without. Phalangeal sub-periosteal erosions were as common in those with histological osteomalacia as in those with histological hyperparathyroidism alone. There was no association between plasma alkaline phosphatase activity and type of bone disease. There was no correlation between the radiological second metacarpal index and the histological volume of cancellous iliac bone.
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