In this review, we have discussed the history, clinical course, and what is known about the epidemiology and pathology of aluminum-related bone disease in patients with renal failure. In addition, we have reviewed current thoughts about prevention and treatment. This disorder of medical progress, along with the other forms of renal osteodystrophy, has provided us important new information about calcium regulation and bone. These insights may well permit better understanding and management of much more common skeletal disorders.