Aluminium Hydroxide - osteodystrophy?

[voicesinmyhead]

Could someone tell me the mechanism of this side effect of Al hydroxide as mentioned in FA pg 379?

Online searches give osteoporosis or osteomalacia as probable side effects, but no mention of osteodystrophy.

Is this an error in FA?

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[tasar1898]

Probably reduced absorption of Ca --> hypocalcemia ~~> Pth ~~~> bone resorption ~~> osteodystrophy. Osteoporosis and osteomalacia could also occur concomittently

 

[deleted500612]

Yeah all I see when googling is osteomalacia as a side effect of aluminum hydroxide, not osteodystrophy. From UpToDate: "Osteomalacia, which is now uncommon, was due primarily to aluminum deposition in bone at a time when aluminum-containing antacids were used as phosphate binders".

In fact, I found a page at U Washington that says aluminum hydroxide was used as a last resort to treat osteodystrophy (phosphate binding in gut --> decreased serum phosphate --> decreased PTH) which makes sense. Looks like maybe an error in FA.

 

[tasar1898]

Why hypophosphatemia causes increase PTH? PTH likes low phosphate , that's it's name actually Phosphate Trashing Hormone.. It couldn't care less about the phosphate loss

Edit: found this on medscape : " In aluminum-related bone disease, the predominant features are defective mineralization and osteomalacia that result from excessive deposits at the site of osteoid mineralization, where calcium would normally be placed."

So if you eat a MASSIVE amount it can cause generalized tissue toxicity via direct deposition, it also binds other useful stuff and "inhibits" them

Also , it seems that osteomalacia is a "subtype" of osteodystrophy

http://emedicine.medscape.com/article/165315-overview#a5