Vitamin-D-Resistant Osteomalacia in Hemodialysis Patients Lacking Secondary Hyperparathyroidism

doi:10.1059/0003-4819-94-5-629

Vitamin-D-Resistant Osteomalacia in Hemodialysis Patients Lacking Secondary Hyperparathyroidism

Los Angeles, California; Seattle, Washington; Honolulu, Hawaii; Sepulveda, California; Denver, Colorado; and Riverside, California

Abstract

We describe a sporadic, vitamin-D-resistant osteomalacic syndrome in 19 patients undergoing hemodialysis. The syndrome was found in less than 1.5% of patients from referring dialysis centers. All 19 patients had multiple fractures, severe myopathy, and many developed spontaneous hypercalcemia. Severe osteomalacia without evidence of secondary hyperparathyroidism distinguished this syndrome from other forms of renal osteodystrophy. Bone aluminum, measured in six patients, was greatly elevated. Therapy with calcitriol (1α, 25-dihydroxycholecalciferol) led to clinical improvement in seven patients with reduced pain and myopathy, decreased serum alkaline phosphatase, or both, but no improvement in bone histology. Patients who did not respond clinically to calcitriol developed marked hypercalcemia. The cause of this severe osteomalacia, which occurs despite normal or slightly elevated levels of serum calcium and phosphorus and fails to mineralize with calcitriol, is unclear.

Article and Author Information

▸From the Research Services, Veterans Administration Wadsworth Medical Center, the Department of Medicine, University of California School of Medicine and University of Southern California School of Medicine; Los Angeles, California; the Medical Service, Veterans Administration Hospital, Department of Medicine, University of Washington School of Medicine; Seattle, Washington; Institute of Renal Diseases, St. Francis Hospital, Department of Medicine, John A. Burns School of Medicine; Honolulu, Hawaii; the Medical Service, Veterans Administration Hospital; Sepulveda, California; the Medical and Research Services, Veterans Administration Hospital; Denver, Colorado; and the Department of Biochemistry, University of California; Riverside, California.
Grant support: in part by Grant AM 14750 and Contract AM 72204 from the U. S. Public Health Service and Veterans Administration research funds.
▸Requests for reprints should be addressed to Jack W. Coburn, M.D.; Veterans Administration Wadsworth Medical Center, Sawtelle and Wilshire Blvds.; Los Angeles, CA 90073.