Periosteal New Bone Formation (Periosteal Neostosis) in Renal Osteodystrophy

Radiologic skeletal surveys in 117 patients with severe chronic renal disease revealed periosteal neostosis (periosteal new bone formation) in 10 patients (8.5%). Periosteal neostosis occurred in varied locations and was always accompanied by subperiosteal resorption in finger bones, and in 9 of 10 cases by osteosclerotic changes in the central skeleton. The most common finding in iliac crest biopsies, obtained from 8 patients, was osteoid excess (osteomalacia). The combination of periosteal neostosis, subperiosteal resorption, osteosclerosis, and osteoid excess may be a manifestation of secondary hyperparathyroidism, with high bone turnover and sustained ability to produce mineralized bone.