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Is renal osteodystrophy reversible?

In order to investigate the possible reversibility of renal osteodystrophy, eleven necrograft recipients were investigated six years after transplantation, when treatment with prednisone had been withdrawn for 1.5 years. Serum ionised calcium, phosphorus, alkaline phosphatases, PTH, skeletal radiography, Technetium polyphosphate (Tc-PP) bone scintigraphy and radial bone mineral content (BMC) were studied. Normal blood biochemistry, radiography and Tc-PP scintigraphy were found in nine (82%) of the patients, in contrast to the considerably higher frequency of abnormalities ordinarily found in haemodialysis patients. However, the radial BMC was significantly reduced (mean 13.5%) and identical with the BMC value in haemodialysis patients. We conclude that some regression of renal osteodystrophy may take place after a successful kidney transplantation, but that decreased mineralisation of the appendicular skeleton persists. Whether this latter finding is due to long-term steroid treatment or is an indicator of an irreversible component in renal osteodystrophy cannot be stated.