Radiographic manifestations of aluminum-induced bone disease.

The toxic effects of aluminum have been recognized in recent years as the cause of a number of important disorders, particularly in patients on long-term hemodialysis for chronic renal failure. The predominant clinical features include dementia [1], myopathy [2], and bone disease [3]. Initial studies of aluminum-induced bone disease demonstrated that fractures were significantly more common in patients exposed to high dialysate aluminum concentration and phosphate binders [3]. Whereas most of the early investigations concentrated on linking the aluminum level of the dialysate to induction of bone disease, recently excessive ingestation of antacids has been found to be a more important source of aluminum toxicity. Severe osteomalacic changes were found in patients treated with aluminum-containing antacids [4, 5]. We describe the radiographic manifestations of aluminum-induced bone disease in two hypencalcemic patients. Both received longterm, high-dose antacid therapy. After the diagnosis of aluminum-induced bone disease was made by iliac crest bone biopsy, each patient improved dramatically on defenoxamine therapy with rapid fracture healing.