Does anyone know if there is any clear way to distinguish between renal osteodystrophy and osteoporosis, and whether treatments for each differ in any significant way?
My wife (53) has end stage renal failure, following 20+ years of NSAID treatment for a virulent form of ankylosing spondylitits, and has been on home periotoneal dialysis since May 2002. A kidney transplant is unlikely. Cyclophosphamide prescribed 1981-89 caused early menopause & she had HRT treatment 1991 to 2003 (stopped after the HRT scares).
On PD she's had persistently elevated serum phosphate but normal calcium levels. In my country the only phosphate binders available to her are alu-tabs, calci-tabs, or Milk of Magnesia. Her rheumatologist diagnosed osteoporosis over a year ago and she has refused alu-tabs in view of their association with bone problems and dementia. Calci-tabs lower her serum phosphate but quickly cause hypercalcaemia so are invariably stopped within 4 weeks whenever prescribed by her renal doctors. Her renal doctors say Renagel or Fosrenol are not approved for use here, so are not available and cannot even be prescribed for her. Milk of Magnesia is prescribed as her normal binder but only has minimal effect.
Confined to a wheelchair in December 2003 (a hip replacement had come loose and further surgery is considered too risky) for the last 3 months she has been confined to bed, unable to sit without extreme lower back and buttock pain. A CT scan has just revealed "insufficiency fractures" in her pelvis and tailbone as the cause. We've been unable to obtain from any of her doctors a clear diagnosis of whether this is the result of renal osteodystrophy or osteoporosis - and therefore what is the best treatment. She is of very slight build and has been on 40 mg Fosamax once weekly since February 2006 but clearly this has come too late to prevent significant bone loss.
I need to know if it is possible to distinguish between renal osteodystrophy and osteoporosis, and whether treatments for each differ, so I can try and find out if there is anything we can do to reverse her bone loss.