PubMed · 13405171
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P ROYER. 1957-01-10. [Vitamin-resistant rickets].. https://pubmed.ncbi.nlm.nih.gov/13405171/
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Accurate measurements of parathyroid hormone (PTH) in plasma are necessary for the assessment, monitoring, and therapy of disorders of bone and mineral metabolism including renal osteodystrophy. Assays for PTH have evolved to provide 2-site immunometric assays that are highly specific for the intact 84 amino-acid peptide, PTH (1-84). With the advent of such assays, it has been shown that the prior generation of assays, thought to measure intact PTH, in fact, also detected a PTH peptide that was truncated at the N-terminus and that appeared to be similar to PTH (7-84). There has been renewed interest in such circulating PTH fragments in view of the demonstration that PTH (7-84) (and other PTH peptides) might have biologic effects. These effects include an action to oppose the calcemic effect of PTH in vivo and to inhibit bone resorption and osteoclast generation in vitro. These effects appear to be mediated by actions of a receptor for PTH peptides with specificity for the C-terminal region of PTH and distinct from the PTH receptor known to be responsible for all of the classic actions of PTH. Although the C-PTH receptor has not yet been cloned, the observations have opened a new field of research in parathyroid physiology. Clinical applications of the assay of such PTH fragments in relation to the amount of circulating PTH (1-84) concentrations are being sought actively as the new PTH assay methodology is applied to the clinical arena and as the biology of the C-PTH receptor and C-terminal PTH fragments are investigated.
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Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.