Bone aluminum deposition in maintenance dialysis patients treated with aluminium-free dialysate: role of aluminium hydroxide consumption

Determination of trace elements and calcium in bone of the human iliac crest by atomic absorption spectrometry

A rapid and reliable analytical method for the determination of trace elements in human bone by atomic absorption spectrometry is reported. Calcium was determined to estimate the homogeneity of samples. Human bone from the iliac crest was obtained at autopsy of adult subjects. Before analysis samples were decomposed by microwave digestion and acid digestion in a Parr bomb. Zinc, rubidium, strontium, calcium and iron were determined by flame atomic absorption spectrometry (FAAS) and aluminium, copper and lead by electrothermal atomic absorption spectrometry (ETAAS) at optimum measurement conditions. The results for the two digestion procedures agreed for zinc, rubidium and calcium within +/-5%, for copper within +/-7% and for strontium, iron, aluminium and lead within +/-10%. The repeatability of measurement (R.S.D.) for determination of calcium and trace elements after microwave digestion and acid digestion in a Parr bomb was tested in one representative autopsy bone sample by six parallel determinations. It was found to be better than +/-5% either for microwave digested samples or samples digested in a Parr bomb, for all elements determined by FAAS and ETAAS techniques. The accuracy of the applied digestion procedures was checked by analysis of trace elements in NIST SRM 1486 Bone Meal reference material. Good agreement of the results with certified values was obtained for both digestion procedures. The microwave procedure developed for digestion of small amounts of sample was applied in trace elements analysis of bone biopsy samples from dialysis patients.

Determination of aluminium in samples from bone and liver of elderly Norwegians

Recent reports associating aluminium with several skeletal and neurological disorders in humans suggest that exposure to aluminium may pose a health hazard. In connection with an epidemiological study on aluminium and Alzheimer's disease, information on the body burden of aluminium was needed. Aluminium is stored in the body mainly in bone and soft tissues such as the liver. Therefore, an analytical procedure was developed for the determination of aluminium in the head of femur and the liver using graphite furnace atomic absorption spectrometry. Problems in such analyses are associated with low levels of aluminium, risk of contamination during sample preparation, inhomogeneity of the sample tissues, and complexity of the matrices. Bone samples gave poorer repeatability compared to liver samples and up to four replicate analyses were performed. In the analyses of the digested bone samples, severe chemical interference occurred when these either contained much dissolved bone mineral or had a high A1 concentration. It is possible that this interference is brought about by formation of aluminium phosphate in the graphite tube. The analytical results for bones are given relative to ash weight because the samples sometimes contained a lot of fat. The ash weight of the bone tissue varied between 8 and 69 per cent. The material consisted of 84 samples of head of femur and 95 liver samples from deceased elderly Norwegians. Two cases had high A1 levels in bone (16.8 and 18.0 mg/kg ash weight) and liver (10 and 22.7 mg/kg dry weight) tissues. The remaining cases showed about ten to fifteen-fold variation of the A1 level in both liver (0.4 - 5.7 mg/kg) and bone (0.5 - 5.8 mg/kg). There was no correlation between the level in liver and bone when the two cases with the highest levels were excluded.

Renal osteodystrophy

Over the past decade important advances in our understanding of the pathophysiology and treatment of renal osteodystrophy have been made. In particular, the role of calcitriol deficiency in the genesis of hyperparathyroidism in early renal failure is now better understood. So too are the effects of aluminium on bone, and whereas the more florid aluminium related disease is now unusual the more subtle effects of aluminium are now being appreciated. There is still a major problem in the long-term treatment of hyperparathyroid bone disease. The reasons why parathyroid gland proliferation continues to occur on dialysis therapy require a better understanding of cellular events regulating hormone production and parathyroid cell replication. The case for early intervention with vitamin D is now strong but whether such an approach materially influences the long-term outcome is not yet established. Changes in the approach to treatment and in the modalities used for renal replacement therapy will continue to modify the nature of the bone disease.

The effect of oral aluminium salts on the bone of non-dialysed uremic patients

12 patients with conservatively treated uremia were investigated using bone histomorphometry, bone aluminium concentration determination and total body bone mineral content (TBBM). The bone aluminum was raised in 10 patients and was significantly related to oral aluminium salt consumption (p less than 0.01). Two of four patients who had not received aluminium also had raised levels but the difference was not significant from nonuremic patients. The two patients with the highest levels had a mineralisation defect despite normal levels of 1,25-dihydroxyvitamin D. Three patients had significant bone loss of whom one had osteomalacia (OM) while two had secondary hyperparathyroidism (2HP). It is concluded that 1) aluminium salt consumption results in bone aluminium accumulation, and may contribute to the mineralisation defect; 2) uremic patients not treated ith aluminium salts may have slightly raised levels, but this seems not to be clinically important; 3) secondary hyperparathyroidism causes greater destruction of bone mass than other uremic bone diseases; 4) atomic absorption spectrometry is a more sensitive method for detecting aluminium bone deposition than histochemical methods.