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September 19, 1986

Dialysis-Associated Bone Disease

Author Affiliations

Institute of General Clinical Medicine Pisa, Italy

JAMA. 1986;256(11):1447. doi:10.1001/jama.1986.03380110053024

To the Editor.—  I read Dr Glassock's1 conclusions in CONTEMPO '85 and his reply to the letter from Dr Daves2 concerning bone disease in end-stage renal failure. Aluminum intoxication plays a role in the pathogenesis of this complication, but there are other factors. Our understanding will be incomplete if we do not analyze the role played by heparin in the etiology of dialysis osteodystrophy.The development of osteopenia due to long-term heparin therapy in patients without renal disease has been documented,3 but the mechanism remains unclear. In bone culture, heparin shows a tissue resorptive power higher than that of parathormone4 and at the same time interferes with bone collagen, causing an increase in collagen metabolism and modification of its structure.5 Heparin also inhibits the conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D by a direct effect on 1α-hydroxylase6 and on the activity of