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Renal Osteodystrophy — ESENeph MCQ

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ModerateChronic Kidney DiseaseRenal OsteodystrophyESENeph

A 70-year-old man with CKD G5D on haemodialysis presents with bone pain and a fracture following minimal trauma. His PTH is 95 pmol/L, ALP is markedly elevated, calcium is 2.1 mmol/L, and phosphate is 2.3 mmol/L. X-ray shows rugger-jersey spine appearance. What type of renal osteodystrophy is most likely?

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Correct answer: E — Osteitis fibrosa cystica (high-turnover bone disease)

High PTH, elevated ALP (indicating high bone turnover), and rugger-jersey spine on X-ray are characteristic of osteitis fibrosa cystica (high-turnover renal osteodystrophy). This is caused by secondary hyperparathyroidism driving excessive osteoclastic bone resorption. Adynamic bone disease has low PTH and low ALP. Osteomalacia shows low calcium with Looser zones. Treatment involves controlling hyperparathyroidism with calcimimetics and/or parathyroidectomy.

Reference: KDIGO 2017 – CKD-MBD Guideline Update