What are the factors contributing to secondary hyperparathyroidism and high-turnover bone disease?
The factors responsible for secondary hyperparathyroidism associated with Chronic Kidney Disease include:
• Hyperphosphatemia from diminished kidney phosphorus excretion
• Hypocalcemia, impaired kidney production of active 1,25-dihydroxyvitamin D (calcitriol)
• Alterations in the control of PTH gene transcription
• Skeletal resistance to the calcemic action of PTH
• Fibroblastic growth factor 23 (FGF23), which may indirectly promote hyperparathyroidism by inhibiting production of 1,25-dihydroxyvitamin D
