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Use of the Deferoxamine Infusion Test in the Diagnosis of Aluminum-Related Osteodystrophy

DAWN S. MILLINER, M.D.; HENRY G. NEBEKER, M.D., Ph.D.; SUSAN M. OTT, M.D.; DENNIS L. ANDRESS, M.D.; DONALD J. SHERRARD, M.D.; ALLEN C. ALFREY, M.D.; EDUARDO A. SLATOPOLSKY, M.D.; and JACK W. COBURN, M.D.
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Grant support: in part by grants AM-14750, AM-29926, AM-9976, and AM-7126; from the National Institutes of Health, Public Health Service, and by General Clinical Research Center Grants RR-37 (CLINFO computer system) and RR-865. Dr. Milliner was a Mayo Foundation Scholar at the Wadsworth Veterans Administration Medical Center at the time of the study. Dr. Coburn is a Medical Investigator of the Veterans Administration.

Presented in part at the VIII International Congress of Calcium Regulating Hormones, Kobe, Japan, 16 to 24 October 1983; and at the meeting of the American Society of Nephrology, Washington, D.C., 4 to 6 December 1983.

▸Requests for reprints should be addressed to Dawn S. Milliner, M.D.; Division of Nephrology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.


Los Angeles, California; Seattle, Washington; Denver, Colorado; and St. Louis, Missouri


Ann Intern Med. 1984;101(6):775-780. doi:10.7326/0003-4819-101-6-775
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The accumulation of aluminum in bone can cause disabling osteodystrophy in patients with renal failure. Because the chelating agent deferoxamine can mobilize aluminum from tissues, we evaluated the effect of a standard intravenous dose of deferoxamine on plasma aluminum concentrations in 54 patients on hemodialysis. Stainable bone aluminum, bone histologic findings, and bone aluminum content were studied. Baseline plasma aluminum concentrations of greater than 200 µg/L were associated with aluminum-related osteodystrophy (specificity, 93%), but concentrations of less than 200 µg/L did not exclude the diagnosis (sensitivity, 43%). After administration of deferoxamine, the increase in plasma aluminum concentration was 534 ± 260 (SD) and 214 ± 92 µg/L in patients with and without aluminum-related bone disease, respectively (p < 0.001), and correlated with the bone aluminum content (r = 0.64). An increment in plasma aluminum concentration of greater than 200 µg/L identified 35 of the 37 patients with aluminum-related osteodystrophy; sensitivity was 94% and specificity, 50%. The deferoxamine infusion test is noninvasive, well tolerated, and of value particularly in excluding the diagnosis of aluminum-related osteodystrophy.

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