Transverse fractures of the spinous process of the 7th cervical vertebra were noted in 2 patients and of the 1st thoracic vertebra in 1 patient on maintenance hemodialysis. Two patients with aluminum (Al)- and/or iron-related bone disease complained of bone pain, relieved by deferoxamine therapy. In all three cases, the bone fractures had occurred suddenly while the patients were going about their daily work. These observations indicate that Al- or iron-related bone disease with secondary hyperparathyroidism can induce bone fracture by only slight stress in patients maintained on hemodialysis.