What is the most common cause of skeletal abnormality in a case of renal osteodystrophy?

Renal osteodystrophy combines features of secondary hyperparathyroidism, rickets, osteomalacia, and osteoporosis. The primary retention of phosphate by abnormal kidneys results in hyperphosphatemia, which causes hypocalcemia, resulting in secondary hyperparathyroidism. Therefore, the spectrum of clinical and radiographic findings in renal osteodystrophy may be a manifestation of any of these disorders. The most common complication of renal osteodystrophy is fracture, which may be insufficiency fractures through osteomalacic bone or pathologic fractures through brown tumors or amyloid deposits. Dialysis patients may experience carpal tunnel syndrome, osteomyelitis, septic ahritis, and osteonecrosis. Renal transplant patients may experience osteonecrosis, tendinitis, tendon rupture, and fracture.