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September 1969

The Problem and Unanswered Questions: Renal Osteodystrophy, Soft Tissue Calcification, and Disturbed Divalent Ion Metabolism in Chronic Renal Failure

Author Affiliations

Los Angeles

From the departments of medicine, Cedars-Sinai Medical Center (Drs. Kleeman, Massry, and Popovtzer); Veterans Administration Center (Dr. Coburn); and UCLA School of Medicine, Los Angeles. Dr. Massry is an established investigator of the American Heart Association.

Arch Intern Med. 1969;124(3):262-268. doi:10.1001/archinte.1969.00300190002002

For many decades it has been known that there is a close relationship between renal disease, osseous changes, and "parathyroid hyperfunction," or hyperplasia of the parathyroid glands.1-4 However, due to the apparent infrequency of clinically demonstrable bone disease, serious attention was not paid to this problem in the United States until the excellent British studies of Stanbury5 and Dent et al6 appeared. Although not conclusively demonstrated, it seemed that the incidence of renal osteodystrophy together with chronic renal failure was considerably greater in the British Isles than in the United States. It is probable that in the last years of World War II and early postwar period in England, the diet was somewhat deficient in calcium, phosphorus, and vitamin D (absence of fortified dairy products); in addition, the amount of sunlight and ultraviolet exposure is probably significantly less than in most areas of the United States. If