In conclusion, trace elements such as fluoride, magnesium, and aluminum have an effect on bone in renal failure patients. These trace elements affect the different types of ROD differently, influencing bone through different modes of action. Fluoride interfered with bone mineralization and increased osteoid content, which was most evident in osteomalacia and the mixed bone disorder. In addition, fluoride may interact with aluminum to worsen the osteomalacic lesion. Magnesium appeared to affect b
Discussion
These data indicate that a patient maintained by hemodialysis in a community using fluoridated water may be exposed to a fluoride concentration higher than that present in tap water if the deionizer is allowed to become exhausted while the patient is being dialyzed. The concentration reached 520 uM in the laboratory deionizer and 230 M in the patient's model. Since the concentration of fluoride in blood returning from the dialyzer is about one-half to two-thirds that in the dialysate
In conclusion, we believe our experience indicates that patients maintained on long-term hemodialysis using fluoridated water for periods of years will encounter an unacceptable frequency and degree of osteomalacia. Although some bone disease, in the form of osteitis fibrosa, occurs in patients using nonfluoridated water, this is usually reversible by treatment with dihydrotachysterol. It therefore seems prudent to use nonfluoridated water in long-term hemodialysis.
