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. Author manuscript; available in PMC: 2013 Jul 1.
Published in final edited form as: Curr Opin Nephrol Hypertens. 2012 Jul;21(4):389–403. doi: 10.1097/MNH.0b013e3283546ee0

Table 1.

Clinical features of four main categories of bone disease (renal osteodystrophy) in kidney transplant recipients (see also Figure 1)

Type Histopathologic features Biochemical abnormalities Clinical consequences
Hyperactive (high turnover) bone disease (including osteitisfibrosa) Marked increase in bone turnover, irregularly shaped trabecules displaying numerous abnormal remodeling sites, and an unusually high number of bone cells with irregular arrangement and shape

  • High PTH

  • High AlkPhos*

  • Varying levels of calcium and phos.

  • Low 1,25(OH)D level

  • Bone pain

  • Increased risk of fracture

  • Higher graft loss risk?

  • Increased risk of vascular calcification?

  • Higher mortality risk?
Adynamic (low turnover) bone disease Reduced bone volume and mineralization paralleled by a decrease in bone formation. It is also characterized by presence of few osteoid seams and few osteoblasts. Osteoclast number may be low, normal, or high.

  • Low to normal PTH

  • Low AlkPhos*

  • Varying levels of phos.

  • Calcium tends to be high

  • Varying 1,25(OH)D level

  • Increased vascular calcifications?

  • Increased risk of fracture?
Mixed renal osteodystrophy Defective mineralization with or without increased bone formation and increased PTH activity in bone. Increased numbers of heterogeneous remodeling sites and an increase in osteoclast number. Bone volume is variable and depends on a dominant pathogenic cause.

  • High PTH

  • High AlkPhos*

  • Varying levels of calcium and phos levels.

  • Varying 1,25(OH)D level

  • Bone paid

  • Increased risk of fracture?

  • Mortality and graft loss risk?
Osteomalacia (may also be included under low-turnover category) Accumulation of unmineralized matrix in which a decrease in mineralization precedes or is more pronounced than the inhibition of collagen deposition.

  • Varying levels of PTH, AlkPhos, calcium and phos.

  • Usually low 1,25(OH)2D and 25-OH-D levels

  • Increased risk of fracture?

  • Higher risk of osteoporosis

  • Bone pain and discomfort
*

Bone specific AlkPhos is preferred but total (non-specific) AlkPhos can be used after ruling out liver disease or other non-bone sources of circulating AlkPhos.