Coexistence of Low Muscle Mass and Osteoporosis as a Predictor of Fragility Fractures in Long-Term Kidney Transplant Recipients

Abstract

<b><i>Introduction:</i></b> Sarcopenia and osteoporosis are highly prevalent among kidney transplant recipients (KTRs). Although osteoporosis is known to increase fracture risk in KTRs, it is unclear whether sarcopenia or osteosarcopenia is associated with this increased risk. Thus, we aimed to investigate the association of the coexistence of low muscle mass (LMM) and osteoporosis with the risk of fracture in long-term KTRs. <b><i>Methods:</i></b> Exactly 342 stable KTRs underwent dual-energy X-ray absorptiometry and skeletal muscle mass index (SMI) measurement using bioelectrical impedance analysis. <b><i>Results:</i></b> LMM and osteoporosis were observed in 109 (31.9%) and 93 patients (27.2%), respectively. During a follow-up period of 5.1 years, 48 (14.0%) fractures occurred. KTRs with LMM had a higher fracture risk, but this was not significant (adjusted hazard ratio [aHR] 1.82, 95% confidence interval [CI] 0.94–3.50, <i>p</i> = 0.073). Similar results were obtained in KTRs with osteoporosis (aHR 1.84, 95% CI 0.96–3.47, <i>p</i> = 0.063). We divided the KTRs into four groups according to the presence of LMM and/or osteoporosis. The cumulative incidence rates of fractures were 13.0%, 11.1%, 10.5%, and 31.3% in the KTRs without both LMM and osteoporosis, those with LMM alone, those with osteoporosis alone, and those with both, respectively. The KTRs with both LMM and osteoporosis had a 2.92fold higher risk of fractures (95% CI 1.29–6.49; <i>p</i> = 0.010) than those without both LMM and osteoporosis. <b><i>Conclusion:</i></b> Long-term KTRs with the coexistence of LMM and osteoporosis had an independently higher risk of fragility fractures than those without both LMM and osteoporosis. The combination of SMI and osteoporosis definitions can be used to identify KTRs with a high fracture risk.

Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management

“…There is evidence showing that osteopenia and osteoporosis in the total hip BMD were associated with a significantly increased risk of fracture compared to normal BMD, independent of age, sex and diabetes status [8]. Hori et al showed that a combination of both low muscle mass and osteoporosis increases the risk of fragility fractures (31.3%) compared with low muscle mass (11.1%) and osteoporosis (10.5%) alone [57]. Moreover, certain drug classes contribute to the risk of fragility fractures post-transplantation.…”