Bone Mineral Density After Kidney Transplantation

Wh, Grotz; Fa, Mundinger; Gugel, B; Vm, Exner; Kirste, Günter; Pj, Schollmeyer

doi:10.1097/00007890-199504150-00010

Cited by 145 publications

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“…Previous studies have demonstrated a 30 to 35% increase of the incidence of lumbar fracture following heart and liver transplantation and an 8 to 17% loss of BMD within 1 yr following kidney transplantation (1)(2)(3)(4)(5). However, little is known about the effect of BMT on the skeletal system.…”

Section: Discussionmentioning

confidence: 99%

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The Skeletal Site-Differential Changes in Bone Mineral Density Following Bone Marrow Transplantation: 3-Year Prospective Study

et al. 2002

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INTRODUCTIONWith improved survival following transplantation, increasing importance is now being placed upon the long-term effects of therapy including osteoporosis. Several reviews regarding bone complications in transplanted patients have appeared in the literature (1-5). Most of these works refer to renal, hepatic, and cardiac transplants, whereas references to bone marrow transplantation (BMT) remain scarce, especially about the long-term changes in bone mineral metabolism. Bone diseases following BMT show several differences from those following other organ transplants. BMT recipients are relatively young and the duration of immunosuppressive therapy is usually short. The duration from diagnosis to BMT is relatively short, and thus pre-transplant bone mineral density (BMD) in BMT is higher than those in other solid organ transplantation (6). However, loss of bone mineral density is usually detected following BMT in short-term studies (6-9).We previously reported one-year change of bone mineral metabolism in which early bone loss is significant after BMT (7). However, data on the long-term change of BMD following BMT are rare. We observed the changes of yearly BMD during the post-BMT 3 yr and found a unique pattern in the bone loss and recovery according to the skeletal sites. PATIENTS AND METHODSWe prospectively investigated 11 patients (5 females and 6 males) undergoing allogeneic BMT for hematologic diseases (7 with leukemia, 3 with severe aplastic anemia, and 1 with myelodysplastic syndrome). The mean age of patients was 28.7 ±8.6 yr at the time of BMT (Table 1). Each patient received high dose cyclophosphamide (60 mg/kg/day) for two to four days. Six patients also received total body irradiation (TBI, 10-13.2 Gy) as a conditioning regimen. Intravenous cyclosporin A was administered at a dose of 5 mg/kg/day one day before BMT and at 3 mg/kg/day until the 20th day after BMT to the patients in order to prevent graft-versus-host disease (GVHD). Thereafter, oral cyclosporin A at 6 mg/kg/day was begun and continued for 6 to 12 months. Chronic GVHD developed in 3 patients. Established GVHD was treated with a combination of intravenous methylprednisolone or oral prednisolone and cyclosporin A. Doses were tapered when GVHD was controlled clinically.During the 3-yr study period, pre-BMT and yearly BMD were measured. BMDs of the lumbar spine (lumbar vertebrae L2-L4) and of the total proximal femur were measured by dual-energy radiography absorptiometry (DEXA) using a Lunar Expert (Lunar, Madison, WI, U.S.A. Loss of bone mass is usually detected after bone marrow transplantation (BMT) during the early post-transplant period. However, little is known about the long-term effects of BMT on bone metabolism. We have prospectively investigated 11 patients undergoing BMT. Bone mineral density (BMD) was measured before BMT, and 1, 2, and 3 yr after BMT. Serum markers of bone turnover were serially measured before BMT and 1, 2, 3, 4, and 12 weeks, 6 months, and 1 yr after BMT. The mean change in the lumbar spine (L2-4) BMD,...

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Section: Discussionmentioning

confidence: 99%

“…Several reviews regarding bone complications in transplanted patients have appeared in the literature (1)(2)(3)(4)(5). Most of these works refer to renal, hepatic, and cardiac transplants, whereas references to bone marrow transplantation (BMT) remain scarce, especially about the long-term changes in bone mineral metabolism.…”

Section: Introductionmentioning

confidence: 99%

The Skeletal Site-Differential Changes in Bone Mineral Density Following Bone Marrow Transplantation: 3-Year Prospective Study

et al. 2002

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“…Despite these beneficial effects, RT recipients still experience marked degrees of bone loss that develops in short- or long-terms following transplantation. Bone losses in short terms develop quickly [4,5,6,7] in ranges of 7-10% in the first year following renal transplantation [8,9]. Nevertheless, the prevalence of osteopenia or osteoporosis reaches 70% in long-term follow-ups [10,11,12,13,] which increases the risk of bone fractures [11,14].…”

Section: Introductionmentioning

confidence: 99%

Is Klotho F352V Polymorphism the Missing Piece of the Bone Loss Puzzle in Renal Transplant Recipients?

Özdem

Yılmaz²,

Özdem

et al. 2015

Pharmacology

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Background: Bone disorders are next to cardiovascular problems in frequency in renal transplant (RT) recipients. Reduction in 1,25-dihydroxycholecalciferol (1,25D) levels is among the reasons causing bone loss in these patients. Klotho (KL) serves as a co-receptor for fibroblast growth factor 23 (FGF23), and functions in vitamin D metabolism. KL polymorphisms have been identified in several studies, and phenylalanine to valine substitution at amino acid position 352 seemed to be important to KL function. We investigated KL F352V polymorphism and its relation with 1,25D levels in RT recipients. Methods: The study included 25 RT recipients (8 female, 17 male) and 26 (14 female, 12 male) healthy control subjects who were wild (FF) phenotypes in terms of KL F352V polymorphism. RT recipients with (FV, n = 11) and without (FF, n = 14) a heterozygote polymorphism were determined with high resolution DNA melting analysis of KL F352V polymorphism. Serum 1,25D levels were measured using the RIA method. Results: RT recipients with FV phenotype had significantly lower 1,25D levels (17.58 ± 18.38 pg/ml) compared to recipients with FF phenotype (44.91 ± 24.68 pg/ml) and control subjects (28.24 ± 12.13 pg/ml). 1,25D levels in RT recipients with FF phenotype were significantly higher than control subjects. Conclusions: KL F352V polymorphism may increase the expression of FGF23 co-receptor, KL protein and thus may decrease renal expression of 1α-hydroxylase, and/or stimulate 24-hydroxylase in RT recipients. The resultant decrease 1,25D levels may participate in bone loss in these patients.

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“…По данным одномомент-ных исследований, до 40-45% реципиентов как в ранние, так и отдаленные сроки после аллотpанс-плантации тpупной почки (АТП) имеют остеопе-нию, а от 10% до 50% пациентов -остеопороз [7,10,13,14]. По данным проспективных исследований, наиболее быстрые и выраженные потери преимущественно трабекулярной костной ткани (до 14% в год) развиваются в первые 6-24 послеоперационных месяца [4,6,11,20]. В последующие годы (до 6-10 и более лет) потери костной ткани в позвоночнике либо стабилизируются [3,4,10,12,20], либо замедляются, и минеральная плотность костной ткани (МПК) постепенно нормализуется [5,11].…”

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“…По данным проспективных исследований, наиболее быстрые и выраженные потери преимущественно трабекулярной костной ткани (до 14% в год) развиваются в первые 6-24 послеоперационных месяца [4,6,11,20]. В последующие годы (до 6-10 и более лет) потери костной ткани в позвоночнике либо стабилизируются [3,4,10,12,20], либо замедляются, и минеральная плотность костной ткани (МПК) постепенно нормализуется [5,11]. Снижение же МПК в области бедра может прогрессировать [12,19].…”

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KOSTNYY METABOLIZM I POTERYa KOSTNOY TKANI V OTDALENNYE SROKI POSLE ALLOTRANSPLANTATsII TRUPNOY POChKI (ATP) (ODNOMOMENTNOE ISSLEDOVANIE)

et al. 2005

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Bone turnover markers [osteocalcin (OC), carboxyterminal procollagen I propeptide (PICP), bone alkaline phosphatase (bALP), deoxypyridinoline (DPD), β -crosslaps (CTX), bone acid phosphatase (bACP), parathyroid hormone (PTH)], day calcium excretion (uCaV) and lumbar and hip bone mineral content (BMC) were determined in 195 patients [78 women and 74 men with intact renal function as well as 11 women and 31 men with renal failure (RF)] 40±33 months following KT. KT recipients received triple immunosuppressive therapy (CysA, prednisolone and azathioprine). All groups showed bone remodeling dissociation namely bone resorption increase (high CTX, DPD, bACP) and bone formation retard (mild enhanced level OC, normal or low bALP) in association with high PTH, decreased uCaV and BMC levels. High bone turnover and low uCaV were much more high degree in RF. Vertebral and femur BMC decrease was mild (osteopenia) and only men with RF revealed peripheral osteoporosis. Hyperparathyroidism was associated with decreased transplant function and was main predictor of high bone turnover and bone loss after KT.

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Bone Mineral Density After Kidney Transplantation

Cited by 145 publications

References 0 publications

The Skeletal Site-Differential Changes in Bone Mineral Density Following Bone Marrow Transplantation: 3-Year Prospective Study

The Skeletal Site-Differential Changes in Bone Mineral Density Following Bone Marrow Transplantation: 3-Year Prospective Study

Is Klotho F352V Polymorphism the Missing Piece of the Bone Loss Puzzle in Renal Transplant Recipients?

KOSTNYY METABOLIZM I POTERYa KOSTNOY TKANI V OTDALENNYE SROKI POSLE ALLOTRANSPLANTATsII TRUPNOY POChKI (ATP) (ODNOMOMENTNOE ISSLEDOVANIE)

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