The DOI matches its Crossref record.
An Interesting Case of Osteomalacia Due to Antacid Use Associated With Stainable Bone Aluminum in a Patient With Normal Renal Function
Abstract
Antacids containing aluminum and magnesium hydroxide are widely used nonprescription agents for treatment of gastritis and peptic ulcer disease. One of the side effects of these antacids is that they bind phosphate in the gut, resulting in its malabsorption. Short-term use, consistent with the directions on the manufacturer's label, is safe and effective for most patients. Heavy chronic use, even when within label, can cause serious skeletal impairment. This report concerns the case of a 39-year-old pharmacist who self-mediated for peptic ulcer disease with high doses of a potent antacid containing aluminum and magnesium hydroxide. The patient consumed over 18 kg of elemental aluminum and 15 kg of elemental magnesium over 8 years of antacid use. This treatment resulted in the clinical syndrome of severe osteomalacia due to profound phosphate depletion. Bone biopsy revealed stainable aluminum deposits along 27.6% of the total bone surface, which is a unique observation in a patient with normal renal function. Treatment included withdrawing the antacid and supplementation with phosphate, calcium, and vitamin D. She experienced marked subjective and objective improvement with this regimen. This included a striking increase in her bone mineral density occurring over the 2-year follow-up period. This case documents that long-term antacid therapy, even when used by patients with normal renal function and within the manufacturer's label recommendations, can lead to severe phosphate…
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Al in antacids binds with dietary phosphorus and prevents its absorption, resulting in hypophosphatemia and phosphate depletion.
“The Al in antacids binds with dietary phosphorus and prevents its absorption resulting in hypophosphatemia and phosphate depletion (Woodson, 1998).”
From Aluminium toxicosis: a review of toxic actions and effects (2019) · cites this paper as Woodson, 1998
There are case reports of osteomalacia and rickets in infants and adults using Al-containing antacids for the treatment of gastrointestinal illnesses.
“There are case reports of osteomalacia and rickets in infants and adults using Al-containing antacids for the treatment of gastrointestinal illnesses (Chines and Pacifici, 1990; Pivnick et al., 1995; Woodson, 1998).”
From Aluminium toxicosis: a review of toxic actions and effects (2019) · cites this paper as Woodson, 1998
Citations
Cites
No references could be resolved yet.
Research works printed but not linked: 17
- Andress, 1985, Aluminum-associated bone disease in chronic renal failure, J Bone Miner Res, 1, 391, 10.1002/jbmr.5650010503 · DOI
- Carmichael, 1984, Osteomalacia and osteitis fribosa in a man ingesting aluminum hydroxide antacid, Am J Med, 76, 1137, 10.1016/0002-9343(84)90871-4 · DOI
- Cruikshank, 1981, Urinary magnesium, calcium, and phosphate excretion during the magnesium sulfate infusion, Obstet Gynecol, 588, 430
- Eastwood, 1990, Aluminum deposition in bone after contamination of drinking water, Lancet, 2, 462, 10.1016/0140-6736(90)92012-7 · DOI
- Dominguez, 1976, Dietary phosphate deprivation in women and men. Effects on mineral and acid balances, parathyroid hormone and metabolism of 25-OH-vitamin D, J Clin Endocrinol Metab, 43, 1056, 10.1210/jcem-43-5-1056 · DOI
- Greger, 1983, Excretion and retention of low or moderate levels of aluminum by human subjects, Food Chem Toxicol, 21, 473, 10.1016/0278-6915(83)90105-9 · DOI
- Habener, 1976, Relative effectiveness of magnesium and calcium on the secretion and biosynthesis of parathyroid hormone in vitro, Endocrinology, 98, 197, 10.1210/endo-98-1-197 · DOI
- Hughes, 1975, Regulation of serum 1α,25-dihydroxyvitamin D metabolism by inorganic phosphorus, Science, 175, 768
- Kaehny, 1977, Gastrointestinal absorption of aluminum from aluminum-containing antacids, N Engl J Med, 296, 1389, 10.1056/NEJM197706162962407 · DOI
- Lieberherr, 1987, Aluminum action on mouse bone cell metabolism and response to PTH and 1,25(OH)2D3, Kidney Int, 31, 736, 10.1038/ki.1987.60 · DOI
- Maloney, 1982, Histological quantification of aluminum in iliac bone from patient with renal failure, J Lab Clin Med, 99, 206
- Morrissey, 1986, Effect of aluminum of parathyroid hormone secretion, Kid Int, 29, s41
- Ott, 1983, Aluminum is associated with low bone formation in patients receiving chronic parenteral nutrition, Ann Intern Med, 98, 910, 10.7326/0003-4819-98-6-910 · DOI
- Quarles, 1986, Aluminum-associated bone disease, J Bone Miner Res, 1, 319, 10.1002/jbmr.5650010502 · DOI
- Recker, 1977, Evidence for aluminum absorption from the gastrointestinal tract and bone deposition by aluminum carbonate ingestion with normal renal function, J Lab Clin Med, 90, 810
- Russell, 1986, Direct suppression 1,25-(OH)2D3 of transcription of the parathyroid hormone gene, Clin Res, 34, 726A
- Sherrard, 1993, The spectrum of bone disease in end-stage renal failure—An evolving disorder, Kidney Int, 43, 436, 10.1038/ki.1993.64 · DOI
Cited by
Sorted by citations
Human Health Risk Assessment for Aluminium, Aluminium Oxide, and Aluminium Hydroxide
Krewski, D., Yokel, R. A., Nieboer, E., Borchelt, D., Cohen, J., Harry, J., Kacew, S., Lindsay, J., Mahfouz, A. M., & Rondeau, V. (2007) · Journal of Toxicology and Environmental Health, Part B · doi:10.1080/10937400701597766 · Cited by 998
Aluminium toxicosis: a review of toxic actions and effects
Igbokwe, I. O., Igwenagu, E., & Igbokwe, N. A. (2019) · Interdisciplinary Toxicology · doi:10.2478/intox-2019-0007 · Cited by 395
Becaria, A., Campbell, A., & Bondy, S. (2002) · Toxicology and Industrial Health · doi:10.1191/0748233702th157oa · Cited by 283
Metadata
- Authors
- Woodson, G. C.
- Affiliations
- Emory University (US)
- Corresponding author
- Woodson, G.C.
- Venue
- Bone
- Publisher
- Elsevier BV
- Published
- 1998-06
- Volume
- 22
- Issue
- 6
- Pages
- 695-698
- ISSN
- 1873-2763 (ISSN-L)
- 8756-3282
- OpenAlex
- W2163723165
- Cited by
- 104
- References
- 0
- Citations by year
- 2026: 4 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 7 · 2017: 4 · 2016: 5 · 2015: 8 · 2014: 5 · 2013: 8 · 2012: 4
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bone (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Aluminum toxicity and tolerance in plants and animals
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Heavy Metal Exposure and Toxicity
- Keywords
- osteomalacia, aluminum toxicity, antacids, phosphate limitation, self-medication, peptic ulcer, bone biopsy, phosphorus supplementation, calcium and vitamin D supplementation, bone mineral density
- MeSH terms
- Adult, Aluminum, Antacids, Calcium, Female, Humans, Kidney, Magnesium Hydroxide, Osteomalacia, Phosphates, Self Medication, Vitamin D, Bone Density
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
