Improvement of adynamic bone disease after renal transplantation

Abstract

Low bone remodeling and relatively low serum parathyroid hormone (PTH) levels characterize adynamic bone disease (ABD). The impact of renal transplantation (RT) on the course of ABD is unknown. We studied prospectively 13 patients with biopsy-proven ABD after RT. Bone histomorphometry and bone mineral density (BMD) measurements were performed in the 1st and 12th months after RT. Serum PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and osteocalcin were measured regularly throughout the study. Serum PTH levels were slightly elevated at transplantation, normalized at the end of the third month and remained stable thereafter. Bone biopsies performed in the first month after RT revealed low bone turnover in all patients, with positive bone aluminum staining in 5. In the 12th month, second biopsies were performed on 12 patients. Bone histomorphometric dynamic parameters improved in 9 and were completely normalized in 6, whereas no bone mineralization was detected in 3 of these 12 patients. At 12 months post-RT, no bone aluminum was detected in any patient. We also found a decrease in lumbar BMD and an increase in femoral BMD. Patients suffering from ABD, even those with a reduction in PTH levels, may present partial or complete recovery of bone turnover after successful renal transplantation. However, it is not possible to positively identify the mechanisms responsible for the improvement. Identifying these mechanisms should lead to a better understanding of the physiopathology of ABD and to the development of more effective treatments.

Evolution of bone disease after kidney transplantation: A prospective histomorphometric analysis of trabecular and cortical bone

“…This can lead to misinterpreted results and is one of the imitations of our study. The same probably occurred in another published study concluding that adynamic bone disease could improve with KT, as the first BB had less tetracycline labelling than the FW ones . The ideal ‘baseline bone biopsy’ would be at day 0, in living donor recipients taking the tetracycline during the pre‐transplant period.…”

A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation

“…9 However, dynamic parameters of histomorphometry were not studied in most of the patients. In the past, we have shown reversal of aluminum-related osteomalacia 20 and improvement in ABD (mostly aluminum related) 21 1 year after a successful kidney transplant.…”

Cinacalcet Decreases Bone Formation Rate in Hypercalcemic Hyperparathyroidism after Kidney Transplantation

“…However, the number of available patients is quite limited due to the low prevalence of persistent hypercalcemic hyperparathyroidism after kidney transplantation. We and a few other groups have compared historical bone biopsies taken at the time of dialysis or at the time of kidney transplantation with repeated biopsies after a few months to 1 year afterwards [40,41,42]. These data are not comparable to our current data as the former represent bone histomorphometry of CKD stage 5D and/or immediate post-transplantation times in which high doses of steroids are employed and affect bone.…”