Post-transplantation osteoporosis

Abstract

Transplantation is an established therapy for many hematologic disorders as well as for end-stage diseases of the kidney, lung, liver, heart among others. 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 including the contribution of immunosuppressive agents as well as the specific features of bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient will also be addressed.

Inverse association of serum long‐acting natriuretic peptide and bone mineral density in renal transplant recipients

“…Third, bone disease after transplantation is much more complex (2–5, 26, 27). Bone loss after renal transplantation is related to adverse effects of immunosuppressive drugs (glucocorticoids and calcineurin inhibitors) on bone remodeling, the condition of pre‐existing renal osteodystrophy, and the effects of reduced renal function (2, 27). Therefore, our findings should be investigated in long‐term prospective studies before a causal relationship between serum LANP and BMD in renal transplant recipients can be established.…”

Effects of immunosuppressants, FK506 and cyclosporin A, on the osteogenic differentiation of rat mesenchymal stem cells

“…Among those side effects, a considerable decrease in bone mineral density leading to osteoporosis has been demonstrated. Post-transplantation osteoporosis is a well documented phenomenon; patients treated with immunosuppressants often develop osteopenic conditions or bone fractures [9-11]. Similar high-turnover osteopenia related to systemic administration of immunosuppressants has also been observed in rats [12,13].…”

Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults

“…Receiving cytotoxic therapies during this period can have detrimental effects on both growth and bone development [44,54,55]. Aside from not achieving the projected adult height [56,57], decreased bone density can play a role in the development of osteonecrosis and avascular necrosis, leading to high morbidity in adulthood [58,59,60,61]. Kaste et al [62] evaluated 48 allogeneic HSCT recipients aged 21 years and younger for bone mineral density and osteonecrosis in these survivors reporting the cumulative incidence of osteopenia and osteonecrosis in childhood survivors 10 years after transplantation to be 47.7 and 44%, respectively.…”