Renal Glomerular Osteodystrophy

The bone disease seen in patients with glomerular insufficiency takes two main forms: osteitis fibrosa and osteomalacia. Many of the patients have both, the balance depending on the relative degree of vitamin D resistance and parathyroid hyperplasia. Osteomalacia calls for treatment with vitamin D in large doses, whereas removal of parathyroid tissue is mandatory if osteitis fibrosa predominates and there is hypercalcemia or “tertiary hyperparathyroidism.”