A 36-year-old man with chronic kidney disease (CKD), undergoing hemodialysis therapy since 16-year-old, was referred to our hospital for the management of renal osteodystrophy. Fifteen years ago, he began to develop progressive painful changes in his body and face (Fig.
), especially massive enlargement of the jaws and palate (Fig.
). Substantial thoracic cage deformities resembling “pigeon chest” appearance (Fig.
), loss of height (171 to 160 cm), and shortening and clubbing of the distal phalanges were observed (Fig.
). Previous history also included chronic fistulized osteomyelitis of the left jaw, which appeared 5 years ago after a tooth extraction procedure, and fractures in the right clavicle and bilateral femur fractures, requiring the use of crutches to walk. Blood test results on admission showed total calcium level 9.2 mg/dL, phosphorus 8.3 mg/dL, 25-hydroxy-vitamin D of 27 ng/mL, alkaline phosphatase 3534 IU/L (normal range, 40–150 IU/L), and intact...