Adynamic bone revisited: is there progress?

Adynamic or aplastic bone remains an important medical issue in children with chronic renal failure. To prevent the development of adynamic bone during treatment of secondary hyperparathyroidism, clinical recommendations have been made to maintain intact PTH levels at 2 to 4 times the normal values, avoid hypercalcemia, and keep serum phosphorus levels within age-appropriate limits in children with chronic renal failure. Less-calcemic vitamin D analogs and calcium-free and aluminum-free phosphate-binding agents should be used in children who can tolerate these agents. It is important to remember to reduce or discontinue any medication, whether it is vitamin D, a calcium salt, or any other agent that significantly lowers PTH, especially when intact PTH levels decline rapidly (to < 150 pg/mL) and serum calcium levels are higher than 10 mg/dL.