Excerpt:

The concept that osteomalacia becomes progressively worse on chronic dialysis was reinforced by the findings in the repeat bone biopsies in that 6 of the 8 patients showed a significant increase in their osteoid index. . . . Thus, the progression of osteomalacia appears to be the main reason for the increasing incidence of bone pain and pseudofractures which we and others have observed in patients on chronic dialysis for periods longer than 6 months. Jowsey, et al, has reported similar findings. When the patients reported by Kim, et al. are classified in the same manner as ours were, a similar higher incidence of osteomalacia and absence of severe osteitis fibrosa was observed in patients on chronic dialysis for more than 6 months… The reason(s) for the progression of osteomalacia, which we observed in our chronic dialysis patients, remain(s) unclear. Factors which could result in impaired mineralization which must be considered include fluoride, hypermagnesemia, and phosphate depletion.

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