The use of noninvasive diagnostic tools, like the deferoxamine (DFO) test and serum iPTH, to identify aluminum-related bone disease has proved to be inadequate due to false-negative cases; therefore, bone biopsy becomes a necessary diagnostic procedure. Our purpose was to verify whether these non-invasive parameters, appropriately used, may result valid in the identification of patients not at risk of A1 toxicity, therefore restricting the need for histologic evaluation. We studied 68 hemodialyzed patients, aged 49.0 ± 11.6 years, with a M/F ratio of 37/31 and a dialytic age of 85.0 ± 47.0 months, by means of bone biopsy, DFO test and serum C-PTH. 19.1% of the cases had positive stainable Al and/or high bone Al content ( > 60 mg/kg/dw) and could be intoxicated. To obtain the highest sensitivity, we selected the following limit values: the lower limit of increment so far proposed for DFO test positivity ( > 150 µg/l) and a value capable of selecting patients with pathologic osteoclasia for C-PTH ( > 15 ng/ml). With these limits, four different groups of patients were recognized: group A, DFO test positive and PTH high, n = 12; group B, DFO test positive and PTH low, n = 6; group C, DFO test negative and PTH high, n = 30; group D, DFO test negative and PTH low, n = 20. In group B, which could be anticipated as being at higher risk, we actually found the highest (p < 0.05) bone Al content as compared to other groups, associated with a reduced bone formation rate. However, also in group A and D cases with high A1 content and/or positive A1 stain togheter with low bone formation rate were recorded. On the contrary, all patients in group C invariably showed low bone Al content, negative A1 stain and high-normal bone formation rates, therefore representing a category of patients not a risk of A1 toxicity. We suggest that the use of DFO test and serum C-iPTH assay, at the selected threshold levels, may be suitable to identify patients without an important Al burden, not requiring a bone biopsy to rule out the risk of A1 toxici