Renal Osteopathy

In renal osteopathy (synonyms: Azotemic osteodystrophy; Nanosomia renalis; Nephrogenic infantilism; Renal rickets; Renal rickets; Renal osteodystrophy; Renal osteodystrophy with osteopathy; Renal rickets; Renal infantilism; Renal short stature; Renal dwarfism; Tubular damage with phosphate loss; Tubular disorder with phosphate loss; ICD-10 M90. 8 -: Osteopathy in other diseases classified elsewhere) involves bone changes (osteomalacia/bone softening) caused by chronic renal insufficiency (renal weakness). The cause is changes in calcium and phosphate balance (secondary hyperparathyroidism: parathyroid hormone levels ↑, calcium levels ↓).

Radiological signs of renal osteopathy are detectable in up to 50% of patients with chronic renal failure.

The following forms of renal osteopathy can be distinguished:

  • Secondary/tertiary hyperparathyroidism* (parathyroid hyperfunction) with osteitis fibrosa (bone inflammation).
    • Secondary hyperparathyroidism (sHPT) – the cause lies outside the parathyroid glands and stimulates them to produce more parathyroid hormone; usually in the course of end-stage renal failure or vitamin D deficiency
    • Tertiary hyperparathyroidism 8tHPT) – develops from a long-standing secondary hyperparathyroidism, when autonomy of the originally reactive hyperplastic epithelial bodies has occurred.
  • Adynamic bone disease
  • Osteopathy after kidney transplantation

Prevalence peak: From the age of 50, the prevalence for chronic renal failure and therefore renal osteopathy increases steadily.

In advanced renal failure and under chronic dialysis treatment, the prevalence (disease frequency) for the development of renal osteopathy is close to 100%.

Course and prognosis: Treatment of renal osteopathy must be timely to improve or maintain the quality of life of affected individuals. Renal osteopathy leads to increased morbidity (incidence of disease). The skeletal (affecting the skeleton) changes are noticeable at an early stage in the elderly and in patients with diabetes mellitus disease, especially in dialysis patients. Fracture events are frequently observed here. In dialysis patients, the incidence of hip fractures is up to 17 times higher compared with the general population.