Bone Disease after Kidney Transplantation

Bouquegneau, Antoine; Salam, Syazrah; Delanaye, Pierre; Eastell, Richard; Khwaja, Arif

doi:10.2215/cjn.11371015

Cited by 118 publications

(104 citation statements)

References 52 publications

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“…7,19 Specifically, decreased renal function in conjunction with post-KT glucocorticoid use impacts long-term bone health. [19][20][21][22][23] Furthermore, among recipients of all ages, fractures are associated with hospitalization and mortality. 7 These relationships between fracture and sequelae, nevertheless, were established in an era before KT was widely offered to older adults.…”

mentioning

confidence: 99%

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Salter

Liu

Bae

et al. 2019

J American Geriatrics Society

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OBJECTIVES Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age‐related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death‐censored graft loss (DCGL) and mortality. DESIGN This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014. SETTING We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System. PARTICIPANTS The analytic population included 47 815 KT recipients aged 55 years or older. MEASUREMENTS We assessed the cumulative incidence of and factors associated with post‐KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models. RESULTS The 5‐year incidence of post‐KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5‐y increase; 95% confidence interval [CI] = 1.30‐1.45) and vertebral (aHR = 1.31; 95% CI = 1.20‐1.42) but not extremity (aHR = .97; 95% CI = .91‐1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12‐1.60) and extremity (aHR = 1.30; 95% CI = 1.08‐1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11‐2.52), vertebral (aHR = 2.80; 95% CI = 2.44‐3.21), and extremity (aHR = 1.85; 95% CI = 1.64‐2.10) fracture. CONCLUSION Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680–1688, 2019

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confidence: 99%

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Salter

Liu

Bae

et al. 2019

J American Geriatrics Society

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“…BMMD after KT is characterized by changes in bone quality and calcium-parathyroid hormone-vitamin D axis alterations and is related with a low quality of life and a high risk of fracture, morbidity, and mortality [8]. Preexisting renal osteodystrophy at time of KT, effects and consequences of transplantation-specific therapies on bone (immunosuppression), and the effects of reduced renal function after KT are the major associated factors [9].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population

Balcázar-Hernández

Vargas‐Ortega

González-Virla

et al. 2020

International Journal of Endocrinology

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Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. ere is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n � 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n � 30) hypocalcemia, 86% (n � 64) hyperphosphatemia, and 42% (n � 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p � 0.001). All patients had hypovitaminosis D (deficiency: 91% (n � 67); insufficiency: 9% (n � 7)); 40% (n � 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR � 4.17 (95% CI: 1.21-14.44); p � 0.04), hyperparathyroidism at 6 months (OR � 1.84 (95% CI; 1.67-2.06); p � 0.02), hypovitaminosis D at 6 months (OR � 3.94 (95% CI: 1.86-17.9); p � 0.01), and hyperphosphatasemia at 6 months (OR � 1.47 (95% CI: 1.07-2.86); p � 0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.

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“…Outcomes for KTR sustaining a fracture are significantly worse compared with the general population, with a 60% increased risk in mortality [4]. Preventing bone loss and reducing the risk of subsequent fractures among KTR is therefore of great clinical relevance [5,6].…”

Section: Introductionmentioning

confidence: 99%

Effect of Denosumab on Peripheral Compartmental Bone Density, Microarchitecture and Estimated Bone Strength in <b><i>De Novo</i></b> Kidney Transplant Recipients

Bonani¹,

Meyer²,

Frey

et al. 2016

Kidney Blood Press Res

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Background/Aims: In a randomized controlled clinical trial in kidney transplant recipients (NCT01377467) we have recently shown that RANKL inhibition with denosumab significantly improved areal bone mineral density (aBMD) when given during the first year after transplantation. The effect of denosumab on skeletal microstructure and bone strength in kidney transplant recipients is not known. Methods: The purpose of the present bone microarchitecture ancillary study was to investigate high-resolution peripheral quantitative computed tomography (HRpQCT) data from the distal tibia and distal radius in 24 study patients that had been randomized to receive either two injections of denosumab 60 mg at baseline and after 6 months (n=10) or no treatment (n=14). Results: Consistent with the full trial findings, denosumab reduced biomarkers of bone turnover, and significantly increased aBMD at the lumbar spine (median difference of 4.7%; 95% confidence interval [CI] 2.6 - 7.8; p<0.001). Bone quality as assessed by total and cortical volumetric bone mineral density (Tot. vBMD, Ct.vBMD) and cortical thickness (Ct.Th) increased significantly at the tibia, while changes at the radius were less pronounced. The trabecular volumetric BMD (Tb.vBMD), thickness (Tb. Th), separation (Tb.Sp) and number (Tb.N) and the cortical porosity (Ct.Po) at the tibia and the radius did not significantly change in both treatment groups. Micro-finite element analysis (µFEA) showed that bone stiffness increased significantly at the tibia (median difference 5.6%; 95% CI 1.8% - 9.2%; p=0.002) but not at the radius (median difference 2.9%, 95% CI -3.7% - 9.1%; p=0.369). Likewise, failure load increased significantly at the tibia (median difference 5.1%; 95% CI 2.1% - 8.1%; p=0.002) but not at the radius (median difference 2.4%, 95% CI -3.2% - 8.5%; p=0.336). Conclusions: These findings demonstrate that denosumab improves bone density and bone quality in first-year kidney transplant recipients at risk to develop osteoporosis.

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Bone Disease after Kidney Transplantation

Cited by 118 publications

References 52 publications

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population

Effect of Denosumab on Peripheral Compartmental Bone Density, Microarchitecture and Estimated Bone Strength in <b><i>De Novo</i></b> Kidney Transplant Recipients

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