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Having healthy bones is essential to maintaining body structure and mobility. The human skeleton supports body weight and protects the brain and other organs. The skeleton also stores two important minerals—calcium and phosphorus.
In people with bone disease related to kidney failure, bone cells called osteoclasts and osteoblasts are often not in balance. This condition is called renal osteodystrophy. The way these bone cells get out of balance is when calcium, parathyroid hormone (PTH), phosphorus and activated vitamin D are out of balance.
Over time, renal osteodystrophy can cause bones to break easily, harden the soft tissues of the body including the heart and may even lead to a higher death rate in people with end stage renal disease (ESRD).
Calcium is essential for building new bone cells and keeping existing bones strong. Milk, yogurt, cheese and canned fish with bones are rich with calcium, but also provide too much phosphorus for a kidney diet. Sometimes calcium pills are prescribed to provide extra calcium instead of these high-phosphorus foods for people with chronic kidney disease (CKD). If calcium levels in your blood becomes too low due to kidney failure, your parathyroid glands (four small glands in your neck) release a hormone called PTH. If blood calcium levels are too low, the PTH will begin removing calcium from your bones to get calcium blood levels back to normal. Over months and years, as calcium is stripped from the bones, this can make the bones weak, so their texture becomes more like a piece of chalk than of a sturdy bone.
After calcium, phosphorus is the second most common mineral in the body. About 85 percent of phosphorus in your body is stored in your bones and teeth. Phosphorus is found in milk and milk products, whole grains, dried beans and peas, nuts and seeds, organ meats, meat and fish, colas, chocolate and some types of baking powder. In addition, many processed foods contain phosphate additives.
A high blood phosphorus level causes your body to pull calcium from your bones in an attempt to balance all the body’s minerals. When calcium is being pulled from your bones, your bones begin to break down and lose the ability to provide structural support.
Healthy kidneys activate vitamin D. The activated form of vitamin D is called calcitriol. Calcitriol helps the body absorb calcium. Working together, calcitriol helps maintain normal PTH levels, and they carefully balance calcium in your system. When kidneys fail, they stop converting inactive vitamin D to calcitriol. Your body is unable to absorb calcium from food, so it “borrows” the calcium it needs from the greatest calcium storage depot—your bones.
Renal osteodystrophy is often called the “silent crippler” because symptoms do not occur until a patient has been on dialysis for a few years. Typical symptoms can be Bone pain, Joint pain, Bone deformation, Bone fractures, Poor mobility, Early indicators of renal osteodystrophy include high phosphorus and/or high PTH levels, red eyes, itching and sores from calcium-phosphorus deposits.
Children with kidney disease can be especially affected by renal osteodystrophy because their bones are still growing.
