Dr. Moe continues from where she left off last week with a discussion of the basic histology and structure of bone, including a detailed description of how osteoblasts and osteoclasts interact under the influence of various mediators to effect bone remodeling.
New information concerning regulation of osteoclast function by osteoprotegerin is highlighted.
The abnormal physiology of bone in renal failure is developed, and calcium and phosphorus balance associated with various forms of hemodialysis and peritoneal dialysis therapy are presented. The positive calcium balance associated with calcium-containing phosphorus binders is stressed, and data documenting accelerated vascular calcification in coronary arteries in ESRD patients is reviewed. The question of what is a safe calcium x phosphorus product is debated, and the potential role of vascular calcification in the atherosclerotic process is considered.