Oxalate bone disease--an emerging form of renal osteodystrophy

Rosette-like arrays of highly birefringent calcium oxalate crystals are commonly seen in the marrow space of bone biopsy specimens taken from patients with primary hyperoxaluria, particularly if complicated by renal failure. Similar deposits have been described in chronic hemodialysis patients with secondary forms of oxalosis. Large multinucleated histiocytes may be seen surrounding these crystal deposits. Many of these cells are histologically indistinguishable from osteoclasts. We present a patient in whom this histiocytic reaction appeared to be of sufficient magnitude to stimulate bone resorption and to cause severe osteodystrophy. This observation, and those of other investigators reviewed in the discussion, suggest that oxalate deposition within bone may contribute to the pathogenesis of uremic osteodystrophy in chronic renal failure patients with primary or secondary types of oxalosis.     

Periosteal resorption and periosteal neostosis: Comparison of normal subjects and renal failure patients on chronic ambulatory peritoneal dialysis using MOP-3 image analysis system and a grading method

This is the first known attempt to quantitate periosteal resorption (PR) and perisoteal neostosis (PN) by a semi-automatic image analysis system (Zeiss MOP-3). The normal ranges and errors for PR were found to be similar to those of a previous study using a measuring magnifier. The findings in chronic renal failure patients showed that MOP-3 measurements were actually diagnostically slightly less sensitive than the results by a simple grading method. Comparison with plasmaimmunoreactive parathyroid hormone (iPTH) concentrations showed that while the latter had a higher sensitivity for detection of hyperparathyroidism, the radiologic parameters nevertheless showed abnormal PR in 12% of the observations where iPTH was normal. Both PR and PN correlated significantly with iPTH (r=0.55 and 0.30 respectively, P<0.01).     

Identification of Alcohol Abuse: Thoracic Fractures on Routine Chest X-Rays as Indicators of Alcoholism

In a retrospective study, rib and thoracic vertebral fractures were found to be present on postero-anterior and lateral routine chest x-rays of 57 (28.9%) of 198 alcoholic male patients and in 4 (1.8%) of 218 nonalcoholic male control subjects. The magnitude of the increased prevalence (16-fold; p < 0.001) of rib and vertebral fractures in alcoholics suggest that routine chest x-rays should be useful in the identification of problem drinking and may be used, along with other indices, in population screening for alcoholism.     

Age trends of bone mineral mass,muscle width,and subcutaneous fat in normals and osteoporotics

Radiologic measurements of bone mineral mass in the proximal radius, muscle width and thickness of the subcutaneous fat of the forearm were studied in normal men and women throughout the adult age range. Bone mineral mass showed no significant change to age 60 in men and age 50 in women, but fell thereafter. Muscle width declined from age 30 in the male population, though no significant reduction was found in women before age 60. The correlations between these variables also differed between males and females. While bone mineral mass and muscle width tended, in males, to be positively correlated at all ages, in females no significant correlation was found after age 60. In females, however, bone mass and subcutaneous fat were distinctly correlated in the over 60 age group, though no significant correlation was found in males in any age group. In an osteoporotic group, bone mineral mass and muscle width were lower in male patients than in normals of similar age. In female osteoporotic patients, however, while bone mineral mass and subcutaneous fat were less than in normals, muscle width showed no difference.This study was supported by Canadian Medical Research Council Grant MA-3889.