The causal connection of aluminium accumulation in the organism and of toxic aluminium effects on the bone metabolism is at present regarded as extensively ascertained. On the other hand, there is no final consent about the fact which exact pathomechanisms are the basis of the aluminium effects. Apart from the direct interaction of aluminium with osseous transformation processes influences of the aluminium load of the body on significant, modulating the bone turnover extraosseous factors could be proved. Discussions about the complex pathogenetic principles of aluminium-induced bone changes concentrate themselves upon inhibitory effects of aluminium in the process of mineralisation, upon immediate toxicity of aluminium on the bone cells, potential interactions between aluminium and changed NSD-function as well as the influence of the aluminium accumulation on the vitamin-D-balance.