What is an Adynamic Bone Disease?

In the early 1980s, the term 'aplastic' or 'adynamic' bone disease had been introduced. ABD is characterized by low-bone turnover without osteoid accumulation, i.e. with thin osteoid seam. Both rate of collagen synthesis by osteoblasts and subsequent mineralization of bone collagen are subnormal. The latter differentiates ABD from the so-called second low-turnover form, i.e. osteomalacia, which is distinguished from defects in bone formation by an increased mineralization defect and thus a relative excess of osteoid. In ABD, osteoblasts are sparse or absent; so are or are almost no peritrabecular fibrosis or marrow fibrosis (in contrast to osteitis fibrosa). Especially the BFR is significantly reduced and the remodelling sites are sparse.

What are the symptoms of an adynamic bone disease?

Most patients with adynamic bone disease are asymptomatic, but some patients develop bone pain. However, such patients have an increased susceptibility to fractures-possibly due to impaired capability to repair microdamage-and hypercalcemia.

Bone pain — Most patients are asymptomatic at the time of presentation. However, pain is the predominant symptom among patients with adynamic bone disease. Pain results from low bone turnover, which in turn leads to an impaired ability to repair microdamage.
Fractures — Fractures are more common among patients with adynamic bone disease compared with the general population.
Hypercalcemia — Patients with adynamic bone disease may be hypercalcemic. The increase in plasma calcium is also due in part to an attenuated bone uptake of calcium after a calcium load, as with calcium carbonate in the treatment of hyperphosphatemia.
Vascular calcification — Adynamic bone disease can predispose patients to vascular calcification.

What causes adynamic bone disease?

The most common cause for adynamic bone disease is excess calcium and vitamin D. Overloading with high amounts of calcium and vitamin D is a very common treatment of kidney disease, though such a treatment may prevent renal osteodystrophy that is associated with high bone turnover, but could depressed parathyroid hormone levels.

Other causes of adynamic bone disease are:

Continuous ambulatory peritoneal dialysis: This is a type of dialysis in which the filtration occurs within your abdomen. It's different from hemodialysis, in which your blood gets filtered out through a port, usually in your arm. Some peritoneal dialysis fluids contain high levels of calcium. These may decrease parathyroid hormone levels.
Diabetes: Increased glucose and decreased insulin concentrations will decrease the secretion of parathyroid hormone.

How is adynamic bone disease diagnosed?

Diagnosis of Adynamic bone disease:

Adynamic bone disease (ABD) should be suspected in elderly, diabetic, parathyroidectomized patients intensively treated with calcimimetics, calcitriol or analogues, and in those exposed to aluminum or calcium overload either orally or by dialysate with high calcium concentration (3.5mEq/L) for long term.
Bone biopsy is regarded as the gold standard for the diagnosis of ABD.
In dialysis patients, serum iPTH levels less than 2 times the upper limit of the method, especially if associated with normal/reduced alkaline phosphatase (AP) levels, are highly suggestive of ABD.
Elevated serum levels of total alkaline phosphatase in patients without liver disease or elevated levels of bone-specific alkaline phosphatase, practically excludes ABD.
Bone biopsy or desferrioxamine test should be performed in case of aluminum-associated ABD suspection.

What is the treatment of adynamic bone disease?

Any of the predisposing factors towards increased bone resistance to PTH such as hyperphosphatemia, malnutrition, corticoid use, hypogonadism, and others should be avoided.
All the treatments that tend to suppress serum iPTH levels, such as calcium-based phosphate binders, calcitriol or its analogues, calcimimetics, and dialysate with a calcium concentration of 3.5 mEq/L should be avoided.
Phosphorus binder that is free of calcium like sevelamer hydrochloride should be instituted to stop serum phosphorus buildup.
Desferrioxamine should be the drug of choice to manage ABD associated with aluminum toxicity.

What are the risk factors for adynamic bone disease?

Risk factors that may contribute to adynamic bone disease include the use of calcium-containing phosphate binders, high dialysate calcium, and the use of active vitamin D analogs. Other possible risk factors include older age and diabetes.

Why choose Tender Palm Super-Speciality Hospital for Adynamic Bone Disease Treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital has the most trusted team of Nephrologists with advanced diagnostic equipment care for Adynamic Bone Disease treatment in Lucknow, India. Our Nephrology department follows international safety standards and has years of experience in successfully managing disease and conditions like Adynamic Bone Disease.