Frequency of adynamic bone disease and aluminium storage in Italian uraemic patients - Retrospective analysis of 1429 iliac crest biopsies

Background. Adynamic bone disease was initially attributed to aluminium intoxication in association with low circulating levels of parathyroid hormone. More recently adynamic bone disease has been described even in the absence of aluminium intoxication. Purpose of the study. It was the purpose of this retrospective analysis of 1429 iliac crest biopsies sent to our laboratory from 1985 to 1994 by 41 Italian nephrology and dialysis centres to assess the frequency of adynamic bone disease and aluminium accumulation. Methods. Adynamic bone disease was diagnosed by histological and histodynamic (tetracycline labelling) analysis, on the basis of predetermined criteria. Aluminium accumulation was assessed by aluminon histochemical staining. Results. The frequency of adynamic bone disease was fairly constant at approximately 15% from 1985 to 1994. In contrast, aluminium accumulation, defined as positive aluminon histochemical staining, decreased during the same period from 36% to 4%. Conclusions. Our data clearly show a dissociation of the incidence of adynamic bone disease and aluminium accumulation in bone. At least today, given the low prevalence of aluminium intoxication, factors other than aluminium are the main cause of adynamic bone disease.