Delling classified the histologic changes seen in bone biopsies taken from patients with severe chronic renal failure. This recognizes 3 main histologic patterns, but many patients may show a mixed picture.
In all 3 types the bone trabeculae are irregular in shape.
Parameters:
(1) bone turnover
(2) number of osteoblasts and osteoclasts
(3) amount of osteoid (uncalcified bone)
(4) extent of mineralization front
(5) marrow fibrosis
(6) woven bone
|
Feature |
Type I |
Type II |
Type III |
|
bone turnover |
increased |
normal or slightly increased |
increased |
|
osteoblasts and osteoclasts |
both increased |
osteoblasts increased |
both increased |
|
osteoid |
normal or slightly increased |
markedly increased |
increased |
|
mineralization front |
normal |
decreased |
increased |
|
marrow fibrosis |
usually none |
none |
present |
|
woven bone |
none |
none |
present in advanced cases |
|
Type |
Associations |
|
I |
early hyperparathyroidism |
|
II |
osteomalacia (nutritional, aluminum-associated) |
|
III |
severe hyperparathyroidism (osteitis fibrosa) |
Specialty: Surgery, orthopedic
ICD-10: ,
