Periosteal new bone in patients on intermittent haemodialysis: an early indicator of aluminium-induced osteomalacia?

Periosteal new bone forming along the distal shafts of the tibia, fibula and pelvic inlet was observed to be an unusual feature in patients on intermittent haemodialysis. Sequential skeletal surveys of 13 patients exhibiting this feature were reviewed and correlated with the biochemical, histological and clinical data. The radiological features comprised periosteal new bone, minimal or no evidence of secondary hyperparathyroidism, sclerosis (not in the classical 'rugger jersey' spine distribution but affecting, particularly, the femoral heads) and, in several patients, numerous fractures, particularly of the ribs. There were 10 patients with osteomalacia, in seven of whom the features were consistent with aluminium-induced bone disease. We suggest that the finding of periosteal new bone in the above distribution in a patient on intermittent haemodialysis should alert the clinician to the possibility of aluminium intoxication.