Early Rapid Loss Followed by Long-Term Consolidation Characterizes the Development of Lumbar Bone Mineral Density After Kidney Transplantation

Brandenburg, Vincent; Politt, Dirk; Ketteler, Markus; Faßbender, Walter Josef; Heussen, Nicole; Westenfeld, Ralf; Freuding, Thomas; Floege, Juergen; Ittel, T. H.

doi:10.1097/01.tp.0000131990.13277.28

Cited by 72 publications

(49 citation statements)

References 34 publications

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“…Between 3 and 10 mo, a significant decrease in lumbar BMD occurred. However, no further bone loss was noted after the first year, and BMD remained relatively stable but at significantly lower level compared with healthy controls [10] . The causes of bone loss after kidney transplant are numerous and usually multiple factors are present in each patient.…”

Section: Post-transplant Bone Lossmentioning

confidence: 75%

“…Now, it is usually caused by over-suppression of PTH and other growth factors [8,10,11] . Bone biopsy findings include a low bone formation rate as assessed by tetracycline fluorescence-labeling, little or no cellular activity (paucity of osteoblasts and osteoclasts) and thin osteoid seams [6] .…”

Section: Adynamic Bone Diseasementioning

confidence: 99%

“…In addition, hypogonadism is very common, but not routinely screened for or treated among the ESRD population. Chronic metabolic acidosis and uremic osteodystrophy also contribute to bone loss [8,10,11] .…”

Section: Osteopenia and Osteoporosismentioning

confidence: 99%

“…The cumulative bone fracture rate has been reported as high as 17% to 20%, and higher fracture rates are seen in the elderly, females, diabetics, and simultaneous kidney pancreas transplant recipients [2,25,26] . Post-transplant bone fracture is thought to be the consequence of continuing bone loss that is superimposed on preexisting uremic osteodystrophy [10,14,27] .…”

Section: Post-transplant Bone Fracturementioning

confidence: 99%

“…After that, patient may either continue to lose bone at a slower rate, stabilize, or improve BMD depending on numerous factors including medication usage and renal function [10,11] . A study reported 66% of patients with functioning grafts have osteopenia or osteoporosis [28] .…”

Section: Post-transplant Bone Lossmentioning

confidence: 99%

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Metabolic bone diseases in kidney transplant recipients

Zhang

Chouhan²

2012

WJN

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Metabolic bone disease after kidney transplantation has a complex pathophysiology and heterogeneous histology. Pre-existing renal osteodystrophy may not resolve completely, but continue or evolve into a different osteodystrophy. Rapid bone loss immediately after transplant can persist, at a lower rate, for years to come. These greatly increase the risk of bone fracture and vertebral collapse. Each patient may have multiple risk factors of bone loss, such as steroids usage, hypogonadism, persistent hyperparathyroidism (HPT), poor allograft function, metabolic acidosis, hypophosphatemia, vitamin D deficiency, aging, immobility and chronic disease. Clinical management requires a comprehensive approach to address the underlying and ongoing disease processes. Successful prevention of bone loss has been shown with vitamin D, bisphosphonates, calcitonin as well as treatment of hypogonadism and HPT. Novel approach to restore the normal bone remodeling and improve the bone quality may be needed in order to effectively decrease bone fracture rate in kidney transplant recipients.

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Section: Post-transplant Bone Lossmentioning

confidence: 75%

Section: Adynamic Bone Diseasementioning

confidence: 99%

Section: Osteopenia and Osteoporosismentioning

confidence: 99%

Section: Post-transplant Bone Fracturementioning

confidence: 99%

Section: Post-transplant Bone Lossmentioning

confidence: 99%

See 3 more Smart Citations

Metabolic bone diseases in kidney transplant recipients

Zhang

Chouhan²

2012

WJN

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Chronic Kidney Disease‐Mineral and Bone Disorder

Palmer

Strippoli

Craig

et al. 2022

Evidence‐Based Nephrology

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Evaluation of the efficacy and tolerability of alendronate versus denosumab in kidney transplant patients with reduced bone mineral density

Sayed,

El Wakeel,

Elseasi

et al. 2023

Pharmacotherapy

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PurposeTo compare the effect of denosumab and alendronate on bone mineral density (BMD) in renal transplant recipients (RTRs) with low bone mass.MethodsPatients were randomized to receive either denosumab subcutaneously (60 mg/6 months), oral alendronate (70 mg/week), or no treatment for 1 year. The three groups were prescribed daily calcium and vitamin D. Primary outcome was BMD assessed at lumbar spine, hip, and radius and measured by dual‐energy X‐ray absorptiometry (DEXA) at baseline and after 6 and 12 months. Adverse events and laboratory assessments (calcium, phosphate, vitamin D, renal functions, and intact parathyroid hormone) were monitored for all patients. Quality of life was assessed at baseline and after 6 and 12 months for all patients.ResultsNinety RTRs were included in the study (30 in each group). Baseline clinical characteristics and BMD values were comparable in the three groups. After 12 months, lumbar spine T‐score of patients treated with denosumab and alendronate showed a median increase of 0.5 [95% confidence interval (CI): 0.4–0.6] and 0.5 (95% CI: 0.4–0.8), respectively, and patients in the control group showed a decrease of −0.2 (95% CI: −0.3 to −0.1), p < 0.001. Denosumab and alendronate showed a significant comparable gain in T‐scores at hip and radius versus a significant decrease in the control group. Adverse events and laboratory values were similar in the three groups. Both treatments resulted in comparable significant improvement in physical functioning, physical role limitations, vitality, and pain scores.ConclusionDenosumab and alendronate showed comparable efficacy in improving BMD at all measured skeletal sites and were safe and well‐tolerated, with no serious adverse effects reported in RTRs with low bone mass. The study was registered on ClinicalTrials.gov, number NCT04169698.

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Early Rapid Loss Followed by Long-Term Consolidation Characterizes the Development of Lumbar Bone Mineral Density After Kidney Transplantation

Cited by 72 publications

References 34 publications

Metabolic bone diseases in kidney transplant recipients

Metabolic bone diseases in kidney transplant recipients

Chronic Kidney Disease‐Mineral and Bone Disorder

Evaluation of the efficacy and tolerability of alendronate versus denosumab in kidney transplant patients with reduced bone mineral density

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