Renal osteodystrophy is a complication of chronic kidney disease that weakens your bones. It's caused by changes in the levels of minerals and hormones in your blood. The main signs are bone pain and fractures. There's no cure except for a kidney transplant. Dietary changes, medications and surgery can slow its progression.
Renal osteodystrophy is a bone disease that occurs in adults and children with chronic kidney disease.
Your kidneys help regulate mineral levels of calcium and phosphorus in your blood. They also produce calcitriol hormone by activating vitamin D to keep your bones strong and healthy. When your kidneys fail or aren’t functioning as well, they can’t maintain proper levels of these minerals and calcitriol hormone. This can weaken your bones and lead to fractures.
The minerals and hormones that help keep your bones healthy include:
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Bone growth occurs during childhood. As an adult, your bones are in a constant state of turnover and renewal. Old bone tissue breaks down and new tissue takes its place.
Renal osteodystrophy can occur when bone turnover is too fast or too slow. The four main types of renal osteodystrophy include:
People with chronic kidney disease often have higher parathyroid hormone levels. Parathyroid hormone balances calcium levels in your blood by transferring calcium from your bones to your blood. But when parathyroid hormone levels are too high, it can pull too much calcium from your bones. When this occurs, fibrous cysts can form in your bones, making them weak.
Some factors that cause high parathyroid hormone levels include:
This condition is the result of low levels of vitamin D, which is common in people with chronic kidney disease.
Metal toxicity can also lead to osteomalacia. Metals such as aluminum can interfere with bone formation and maintenance. Aluminum is an ingredient in some older phosphorus-binder medications. These medications are no longer recommended for use in people with chronic kidney disease or terminal kidney disease on dialysis. People with kidney disease take phosphorus binders with meals to control high phosphorus levels in their blood. The phosphorus binders prevent phosphorus in their food from entering their bloodstream. Non-aluminum phosphorus binders are now the preferred drugs used to control high phosphorus levels.
Overproduction of FGF23 by certain cancers may cause osteomalacia of malignancy leading to bone fractures.
Bone tissue doesn’t renew itself as it should in people with advanced kidney disease or terminal kidney disease on dialysis. The main cause of adynamic bone disease is excess calcium and vitamin D. Treatment for kidney disease may involve supplementation with high levels of calcium and vitamin D. While this treatment can help prevent renal osteodystrophy associated with high bone turnover, it can also suppress parathyroid hormone levels.
Other causes of adynamic bone disease include:
An imbalance in minerals and hormones can also affect your heart and blood vessels. CKD-MBD is an umbrella term that includes renal osteodystrophy and related cardiovascular disease.
Excess calcium and phosphorus in your blood can cause cardiovascular disease through a process called calcification. Calcium builds up on the inside of your blood vessels. This can lead to hardening of your blood vessels (atherosclerosis), high blood pressure, heart attack and stroke.
Approximately 15% of U.S. adults have chronic kidney disease. Most people who have it are likely to have some degree of renal osteodystrophy. Bone damage becomes more severe after kidney failure and long-term dialysis.
Chronic kidney disease causes renal osteodystrophy. Kidney disease disrupts mineral and hormone levels and normal bone turnover. High and low bone turnover can weaken your bones.
The main symptoms are bone pain and fractures. Some people with early forms of the disease may not have any symptoms.
Your healthcare provider will review your symptoms, along with your medical and family history. They'll also perform a physical exam.
Tests providers use to diagnose this condition include:
Your treatment will depend on the extent of bone damage and kidney disease and whether bone turnover is high or low. The main types of treatments include:
Your provider will also help you manage kidney disease. Keeping up with your treatment plan can help you prevent further bone damage.
You can't prevent renal osteodystrophy, but you can slow down its progression by managing chronic kidney disease. Take your medications, follow your prescribed diet and complete your dialysis treatments. Exercising, quitting smoking and limiting alcohol can also help.
There's no cure except for a kidney transplant. People with chronic kidney disease lose kidney function gradually. Many progress to kidney failure and dialysis. Renal osteodystrophy is a common complication.
Many people with chronic kidney disease also develop heart disease. It's the most common cause of death among people with kidney failure.
Your healthcare provider will track your mineral and hormone levels. They’ll make treatment recommendations to help protect your bone and heart health.
If you have chronic kidney disease, talk to your healthcare provider if you have any bone pain. This may be a sign of renal osteodystrophy.
Most people with chronic kidney disease don’t know they have it until it becomes advanced. Routine checkups with your provider can help you detect kidney disease early. With early detection, you can take steps to slow its progression. This is especially important if you have any risk factors for kidney disease, such as:
A note from Cleveland Clinic
Renal osteodystrophy is one of the many complications of chronic kidney disease. It can weaken your bones and cause bone pain and fractures. If you have kidney disease, your healthcare provider will check the levels of minerals and hormones in your blood regularly. Treatments can help correct any imbalances in these substances. If you have chronic kidney disease, follow your provider’s guidance for your diet, medications and dialysis. You can’t cure this condition, but you can take steps to slow its progression and maintain a good quality of life.
Last reviewed by a Cleveland Clinic medical professional on 08/09/2022.
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