Cytokines and growth factors in renal bone disease

Abstract Renal bone disease or renal osteodystrophy is a common complication of chronic renal failure and represents a spectrum of skeletal abnormalities ranging from high turnover states, such as osteitis fibrosa which is seen with secondary hyperparathyroidism, to states of low bone turnover which include osteomalacia and the increasingly common adynamic bone disease. While each of these abnormalities may be predominant in a specific patient, combinations of these patterns are commonly present. Histologically, osteitis fibrosa is characterized by increased bone turnover with increased osteoblast and osteoclast number and activity leading to increased bone formation and increased bone resorption. An additional feature of osteitis fibrosa, as the name implies, is the presence of endosteal and marrow fibrosis. In contrast, in adynamic bone disease, there is decreased bone turnover, with decreased number and activity of osteoblasts and osteoclasts.