Current Status of Research on Osteoporosis after Solid Organ Transplantation: Pathogenesis and Management

Abstract

Improved survival following organ transplantation has brought to the forefront some long-term complications, among which osteoporosis and associated fractures are the major ones that adversely affect the quality of life in recipients. The pathogenesis of osteoporosis in transplant recipients is complex and multifactorial which may be related to increased bone resorption, decreased bone formation, or both. Studies have shown that the preexisting underlying metabolic bone disorders and the use of immunosuppressive agents are the major risk factors for osteoporosis and fractures after organ transplantation. And rapid bone loss usually occurs in the first 6–12 months with a significant increase in fracture risk. This paper will provide an updated review on the possible pathogenesis of posttransplant osteoporosis and fractures, the natural history, and the current prevention and treatment strategies concerning different types of organ transplantation.

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

“…Accordingly, key observations on the impact of each class on BMD and fracture risk are indicated in table 6, primarily in accordance with the findings of Panday et al in their 2014 review on medication-induced osteoporosis [81]. Recent literature reviews specific to each drug class are also cited to provide the reader with a source of more detailed current information [82][83][84][85][86][87][88][89][90][91]. A focus on three commonly used classes -glucocorticoids, androgen deprivation therapy and aromatase inhibitors -serves to illustrate the potential benefits of strategies to prevent osteoporosis induced by medicines.…”

“…Lan et al [86] Glucocorticoids While all recipients of GCs are at increased risk of bone loss, older men and postmenopausal women are at highest risk with GC doses of >20 mg daily.…”

Modern approaches to correction mineral and bone disorders in kidney transplant recipients

“…Пациентам со сниженной функ-цией почечного трансплантата (СКФ < 60 мл/мин) целесообразнее назначение активных метаболитов витамина D и их аналогов (кальцитриол, альфа-кальцидол). Пероральный прием кальцитриола пос-ле трансплантации почки снижает концентрацию в крови ПТГ, улучшает содержание минеральной массы в костях, но доказательство об уменьшении риска костных переломов отсутствует [11][12][13]31].…”

Abnormally High and Heterogeneous Bone Matrix Mineralization After Childhood Solid Organ Transplantation: A Complex Pathology of Low Bone Turnover and Local Defects in Mineralization

“…With improved graft outcomes and patient survival, adverse effects of long‐term immunosuppressive medication, including skeletal complications, have become a concern. Glucocorticoids (GCs) as well as chronic nephrotoxicity induced by calcineurin inhibitors may lead to delayed growth and pubertal maturation and to secondary osteoporosis and fractures . Pediatric allograft recipients have a sixfold fracture incidence compared with the healthy population and a particularly high risk of developing vertebral fractures and scoliosis …”

“…Glucocorticoids (GCs) as well as chronic nephrotoxicity induced by calcineurin inhibitors may lead to delayed growth and pubertal maturation and to secondary osteoporosis and fractures. (1)(2)(3) Pediatric allograft recipients have a sixfold fracture incidence compared with the healthy population and a particularly high risk of developing vertebral fractures and scoliosis. (4,5) In contrast to adults, most pediatric transplant patients do not have decreased bone mineral density (BMD) as measured by dualenergy X-ray absorptiometry (DXA) and an association with BMD and fractures can often not be clearly established.…”