Changes in bone mineral density following long-term simultaneous pancreas-kidney transplantation

Rocha, Ana; Martins, La Salete; Malheiro, Jorge; Dores, Jorge; Santos, Clara; Henriques, Castro

doi:10.1007/s00774-015-0657-3

Cited by 7 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this retrospective study, we analyzed the results of denosumab therapy in patients after solid organ transplantation. Osteoporosis and osteopenia are common complications in cases of long-term graft transplantation survival ( 17 , 18 ). The different mechanisms of action offered by existing anti-osteoporotic drugs provide alternative strategies for osteoporosis treatment.…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis Therapy With Denosumab in Organ Transplant Recipients

2018

View full text Add to dashboard Cite

ObjectiveOsteoporosis and fragility fractures represent serious complications for the solid organ transplant population. The recommended osteoporosis therapy for organ recipients involves supplementation with calcium and vitamin D and bisphosphonate administration. However, these options can prove limited for patients with impaired renal function. An alternative therapy option is offered by denosumab, a monoclonal antibody that targets receptor activator of nuclear factor kappa-B ligand.Patients and methodsWe evaluated 63 patients with osteoporosis (23 males and 40 females, age 56.4 ± 13.1 years) following solid organ transplantation (15 diabetic patients after simultaneous transplantation of the kidney and pancreas, 34 patients after kidney transplantation, and 14 patients with liver grafts). Osteoporosis was diagnosed according to standard DEXA examination using the Lunar Prodigy apparatus. Transplanted patients with impaired renal function were treated for osteoporosis of the lumbar spine (L-spine) and/or proximal femur with calcium and vitamin D supplementation and 60 mg of denosumab every 6 months between the years 2012 and 2017. The mean duration of the therapy was 1.65 ± 0.7 years.ResultsAfter denosumab therapy, L-spine T-scores improved across the whole group, ranging from −2.7 ± 0.09 to −1.8 ± 1.0 (p < 0.001). T-score values for the proximal femur increased from −2.5 ± 0.8 to −2.0 ± 0.7 after the therapy (p < 0.01). We observed only a mild, statistically insignificant improvement in distal forearm T-scores. The mean increase in L-spine bone mineral density (BMD) was 11.5 ± 6.2% in subjects with osteoporosis at this site and 10.4 ± 6.1% in the case of all patients. BMD of the proximal femur increased by 10.4 ± 8.3% in patients with osteoporosis and by 7.5 ± 7.3% in all patients. Denosumab therapy decreased the prevalence of osteoporosis in the L-spine from 75 to 27% (p < 0.001) and proximal femur osteoporosis from 54 to 36% (p < 0.05). Denosumab therapy reduced elevated levels of osteocalcin and beta-crosslaps (βCTX) in comparison with baseline levels (p < 0.001) across the whole group of graft recipients.ConclusionDenosumab therapy was well-tolerated and improved bone density in our group of solid organ transplant recipients. The indications are that denosumab could be a viable therapeutic option for transplanted patients with osteoporosis, especially in those with renal function impairment or bisphosphonate intolerance.

show abstract

Section: Discussionmentioning

confidence: 99%

Osteoporosis Therapy With Denosumab in Organ Transplant Recipients

2018

View full text Add to dashboard Cite

show abstract

“…Successful pancreas transplantation provides physiological insulin repletion, without the risk of hypoglycemia associated with exogenous insulin administration. Evidence exists that combined pancreas-kidney transplantation leads to improvements in BMD[233], and that fracture rates in patients with T1D are lower after transplantation with a simultaneous pancreas–kidney compared with kidney transplantation alone[234], suggesting that T1D remission by pancreas transplantation favorably impacts fracture risk. However, individuals with T1D undergoing pancreas-kidney transplantation also have end-stage renal disease, which strongly affects bone health.…”

Section: Advanced Glycation End Products-bone Matrix In Diabetesmentioning

confidence: 99%

Bone health in diabetes and prediabetes

Costantini

Conte

2019

WJD

View full text Add to dashboard Cite

Bone fragility has been recognized as a complication of diabetes, both type 1 diabetes (T1D) and type 2 diabetes (T2D), whereas the relationship between prediabetes and fracture risk is less clear. Fractures can deeply impact a diabetic patient’s quality of life. However, the mechanisms underlying bone fragility in diabetes are complex and have not been fully elucidated. Patients with T1D generally exhibit low bone mineral density (BMD), although the relatively small reduction in BMD does not entirely explain the increase in fracture risk. On the contrary, patients with T2D or prediabetes have normal or even higher BMD as compared with healthy subjects. These observations suggest that factors other than bone mass may influence fracture risk. Some of these factors have been identified, including disease duration, poor glycemic control, presence of diabetes complications, and certain antidiabetic drugs. Nevertheless, currently available tools for the prediction of risk inadequately capture diabetic patients at increased risk of fracture. Aim of this review is to provide a comprehensive overview of bone health and the mechanisms responsible for increased susceptibility to fracture across the spectrum of glycemic status, spanning from insulin resistance to overt forms of diabetes. The management of bone fragility in diabetic patient is also discussed.

show abstract

“…Whereas multiple positive effects such as restored renal function, stabilization, or even improvement of diabetic retinopathy [11–13] or neuropathy [14, 15] and reduction in macrovascular disease [16–21] have been reported after the successful transplantation, ongoing decline in bone mineral density and increased number of fractures is often encountered. According to a recent study, 35.4% of subjects after SPK were categorised as having osteoporosis in the lumbar spine, with 39.6% in the femoral neck [22]. The incidence of fractures is very high following SPK, even in comparison with other solid organ recipients [23].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Bone Metabolism in Patients on Waiting List for Simultaneous Pancreas-Kidney Transplantation

Kratochvílová

Brunová

Wohl

et al. 2019

Journal of Diabetes Research

View full text Add to dashboard Cite

Posttransplant osteoporosis, which evolves from preexisting bone pathologies, represents a serious complication with deteriorating consequences. The aim of our study was to evaluate epidemiological data on bone mineral density (BMD) in subjects with type 1 diabetes (T1DM) in advanced stages of diabetic nephropathy indicated for simultaneous pancreas-kidney transplantation (SPK). We retrospectively compiled biochemical and densitometrical data from 177 patients with T1DM at CKD (chronic kidney disease) stages G4-G5 (115 men, 62 women, median age 40 yr, diabetes duration 23 yr) enrolled on waiting list for SPK for the first time between the years 2011 and 2016. Median Z-scores were as follows: lumbar spine (LS): -0.8 [interquartile range -1.75 to 0.1]; total hip (TH): -1.2 [-1.75 to -0.6]; femoral neck (FN): -1.2 [-1.9 to -0.7]; and distal radius (DR): -0.8 [-1.4 to -0.1]. We noted a gender difference in LS, with worse results for men (-1.1 vs. -0.3) even after adjusting for BMI (body mass index) and glomerular filtration (p<0.001). Osteoporotic and osteopenic ranges (based on T-scores) for all major sites were 27.7% and 56.5%, respectively, with similar results across both genders. Women had a significantly higher proportion of normal BMD in LS than men (67.7 vs. 49.4%, p<0.05). Patients with T1DM at CKD stages G4-G5 exhibited serious BMD impairment despite their young age. Men surprisingly displayed lower Z-scores and higher percentages of pathological BMD values in LS than women did. The introduction of adequate preventive measures during the advanced stages of diabetic nephropathy to prevent bone loss is recommended.

show abstract

Changes in bone mineral density following long-term simultaneous pancreas-kidney transplantation

Cited by 7 publications

References 26 publications

Osteoporosis Therapy With Denosumab in Organ Transplant Recipients

Osteoporosis Therapy With Denosumab in Organ Transplant Recipients

Bone health in diabetes and prediabetes

Retrospective Analysis of Bone Metabolism in Patients on Waiting List for Simultaneous Pancreas-Kidney Transplantation

Contact Info

Product

Resources

About