Early Radiographic Manifestations of Secondary Hyperparathyroidism Associated with Chronic Renal Disease

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Abstract
The hands of 29 chronic dialysis patients were evaluated every 3 mo. for subperiosteal, intracortical and endosteal bone resorption using fine-detail radiography and optical magnification. All patients with significant endosteal resorption also had progressive subperiosteal resorption and substantial or progressive intracortical resorption. All patients with a significantly elevated parathyroid hormone or alkaline phosphatase level had radiographic evidence of progressive bone loss. Fourteen (61%) of the 23 patients with well-controlled serum phosphate levels (mean, 4.7 .+-. 0.2 mg/dl) treated with supplemental Ca and dihydrotachysterol nevertheless had increased subperiosteal or endosteal resorption. Serial radiography proved to be a valuable method of evaluating progressive bone resorption.