April 18, 1986

Bone Disease in End-Stage Renal Failure-Reply

Author Affiliations

Harbor-UCLA Medical Center UCLA School of Medicine Torrance, Calif

JAMA. 1986;255(15):2025. doi:10.1001/jama.1986.03370150067020

In Reply.—  Many causes of bone disease in patients with end-stage renal disease have been recognized. As Dr Daves appropriately points out, phosphate depletion induced by overzealous administration of phosphatebinding antacids may be a cause of such bone disease.1 However, my purpose in highlighting aluminum intoxication as a cause of bone disease in patients with end-stage renal failure was primarily to review some of the recent developments in this rapidly emerging field, rather than to indicate the overall importance of aluminum intoxication in the spectrum of bone disease observed in advanced renal failure in both patients who have undergone dialysis and in those who have not.I must differ with Dr Daves' suggestion that aluminum intoxication would not be expected to produce a reduction in bone formation, a conclusion he derives from a comparison with the effects of other toxins such as lead and fluoride. Abundant data in both