H.A. ELLIS, M.D., PH.D.
To the editor: I was most interested to read the paper by Dr. Felsenfeld and colleagues (1) describing osteomalacia in dialysis patients after parathyroidectomy, and wish to suggest that the osteomalacia could have been aluminum-induced.
The characteristic clinical picture of fracturing dialysis osteodystrophy results from a special form of osteomalacia that fails to respond to treatment with the newer vitamin D metabolites such as 1-alpha-hydroxyvitamin D3. Histologic examination shows reduced mineralised bone and excess surface lamellar osteoid comprising abnormally thick seams with an absent or reduced mineralisation front and inconspicuous overlying osteoblasts (2). The unusual histologic feature is the presence
ELLIS H. Aluminum and Osteomalacia After Parathyroidectomy. Ann Intern Med. ;96:533–534. doi: 10.7326/0003-4819-96-4-533_2
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Published: Ann Intern Med. 1982;96(4):533-534.
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