Transplantation osteoporosis

Abstract

In the past two decades, there has been a rapid increase in the number of organ transplanted worldwide, including Brazil, along with an improvement in survival and quality of life of the transplant recipients. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods, as well as the features specific to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis should be instituted prior and in the early and late phase after transplantation, and will also be addressed in this article. RESUMOOsteoporose Pós Transplante. Nas últimas décadas houve um grande aumento no número de transplantes realizados no Brasil e no mundo, o que proporcionou uma melhora na sobrevida e qualidade de vida dos pacientes transplantados. A osteoporose e o aumento da prevalência de fraturas por fragilidade óssea têm se mostrado como uma complicação do transplante. Muitos fatores contribuem para a patogênese da osteoporose relacionada ao transplante. Além disso, a maioria dos pacientes apresenta doença óssea antes do transplante, a qual é secundária à doença grave de base. Este artigo revisa os mecanismos da perda óssea que ocorre tanto na fase precoce quanto na fase tardia após o transplante, como também os fatores específicos envolvidos na perda óssea relacionados ao transplante renal, pulmonar, cardíaco, hepático e de medula óssea. A prevenção e o tratamento da osteoporose em todas as fases do transplante também são abordados neste artigo.

Bone disease after transplantation: osteoporosis and fractures risk

“…Sirolimus: ↓ bone resorption: -inhibit osteoclasts differentiation disease and the presence of concomitant risk factors for osteoporosis (2).…”

“…As advances in immunosuppression therapy and transplant techniques over the last decades have improved allograft and patient survival, new challenges have emerged in the management of long-term complications. Post-transplantation bone disease is a major complication present in most of patients, where low bone mineral density (BMD) increases the risk of fractures and consequently, reduces quality of life and increases mortality (1,2).…”

Post-transplantation osteoporosis

“…The number of organs transplanted has increased along with the survival of transplant recipients. This has resulted in increase of recognition of long-term complications of transplantation such as osteoporosis and fractures (1)(2)(3). Low bone mass and fractures may antedate transplantation, related to traditional risk factors for osteoporosis, effects of chronic illness, and end-stage organ failure and its therapy on the skeleton (Table 1).…”

“…The natural history of post-transplantation osteoporosis suggests that there are two main phases, an early and a late phase; the difference between the two phases is mainly due to the doses of immunosuppressive drugs (2) glucocorticoiDS Glucocorticoids (GCs) are used in most immunosuppressive regimens after transplantation. Typically, in the early phase, which generally encompasses the first 6 weeks after transplantation, steroid doses are generally high (e.g., 30-50 mg/day of prednisone or prednisolone at transplantation followed by rapid tapering to 5-10 mg by 6 months).…”

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“…13 However, many studies report vulnerability to bone loss and osteoporosis after any type of transplant. [14][15][16] Several factors including gonadal failure, prolonged immobility, decreased osteoprogenitor cells, conditioning regimens, vitamin D deficiency, secondary hyperparathyroidism, cyclosporine, high corticosteroid use, and graft-versus-host disease (GVHD) have been reportedly involved in bone loss and osteoporosis after bone marrow transplants. [17][18] However, all studies did not identify bone density deteriorating effects for all of the factors mentioned.…”