Can DXA Predict Fractures in Renal Transplant Patients?

Abstract

Renal transplant patients have a high prevalence of osteopenia, osteoporosis and fractures. The aim of the study was to investigate whether dual-energy xray absorptiometry (DXA) is of value to predict fractures. In 1995-2007, 238 renal transplant patients underwent 670 DXA investigations. Osteopenia (46.0%), osteoporosis (13.9%) and absolute bone mineral density (BMD) (median 0.9, range 0.4-2.0 g/cm 2 ) in the hip region were used to evaluate fracture risk. Data on fractures were collected at the occasion of each DXA, and a questionnaire was filled in by 191 patients at regular outpatient visits. Reported fractures were verified by consultation of medical records. In all, 46 patients had 53 fractures. Cumulative hazard of fracture was significantly different among normal BMD, osteopenia and osteoporosis in the hip (p < 0.0001). A Cox proportional hazard analysis also including age, gender and diabetic nephropathy showed significantly increased fracture risk for osteoporosis (3.5 times, CI 1.8-6.4, p = 0.0001) as well as for osteopenia (2.7 times, 1.6-4.6, p = 0.0003). A significantly increased risk was also found with absolute BMD estimates below the median. Osteopenia and an absolute bone density below 0.9 g/cm 2 in the hip region confer an increased risk of fracture.

Bone Disease after Kidney Transplantation

“…In a Swedish study of 238 kidney transplant recipients, 19% of patients had a fracture over a 12-year follow-up, and those with osteopenia and osteoporosis at the hip had a significantly increased risk of fracture compared with those with normal BMD (relative risks of 2.7 [95% confidence interval, 1.6 to 4.6] and 3.5 [95% confidence interval, 1.8 to 6.4], respectively) (27).…”

Renal Association Clinical Practice Guideline on Post-operative Care of the Kidney Transplant Recipient

“…Recent evidence suggests that prophylaxis with isoniazid in selected population is probably effective and it should be prescribed with pyridoxine to prevent peripheral neuropathy [137]. [139]. In addition bisphosphonates are contraindicated in subjects with eGFR <30 mls/min/1.73 m 2 .…”

Individualized Therapy to Prevent Bone Mineral Density Loss after Kidney and Kidney-Pancreas Transplantation

“…Major concerns include prolonged duration of effect because of reduced renal clearance; the possibility of perpetuating or inducing adynamic bone disease, which could increase fracture risk (33); exacerba-tion of secondary hyperparathyroidism; and a lack of proven patient-level benefit. Despite the increased risk for fracture after kidney transplantation, no study has yet demonstrated that preservation of BMD prevents fracture, although the study of Akaberi et al (34) did report an association between fracture and osteopenia, or a BMD Ͻ0.9 g/cm 2 at the hip. In this context, preservation of BMD might be regarded as an "acceptable outcome" provided that it is achieved with a low risk for adverse effects, is unlikely to result in low bone turnover, and, in the absence of proven patient-level benefits, if treatment allocation is stratified according to perceived fracture risk.…”