Osteoporosis after solid organ and bone marrow transplantation

Abstract

Organ transplantation has become increasingly common as a therapy for end-stage renal, liver, cardiac and pulmonary disease. The population of patients who have survived organ transplantation has grown dramatically over the last 2 decades. Although organ transplant recipients now benefit from greatly improved survival, long-term complications of organ transplantation, such as osteoporosis, adversely affect quality of life and must be addressed. In the early post-transplantation period, the effects of high dose glucocorticoids, combined with other immunosuppressive drugs such as cycosporine A and tacrolimus, cause rapid bone loss particularly at the spine and proximal femur. In this setting, fracture incidence rates as high as 25-65% have been reported. Treatment and prevention strategies must target this early post-transplant period, as well as the patient awaiting transplantation and the long-term transplant recipient. This review will discuss the clinical features of transplantation osteoporosis, the pathophysiology of post-transplantation bone loss and prevention and therapy of this unique bone disease.

Post-Transplantation Osteoporosis

“…The number of organs transplanted has increased along with the survival of transplant recipients. This has resulted in increase of recognition of long-term complications of transplantation such as osteoporosis and fractures (1)(2)(3). Low bone mass and fractures may antedate transplantation, related to traditional risk factors for osteoporosis, effects of chronic illness, and end-stage organ failure and its therapy on the skeleton (Table 1).…”

Bisphosphonates

“…Bisphosphonate treatment blunts that bone loss, reduces fracture risk and is used routinely in many transplant centers (69,70).…”

Allogeneic stem cell transplantation from donors with mosaic Turner syndrome

“…Loss of specific genes located on the Xchromosome are thought to be responsible for a range of disorders, including osteoporosis, hypothyroidism, diabetes mellitus (DM), cardiovascular and gastrointestinal diseases, ophthalmic disorders, as well as various immunological defects. 1,2 We report two cases of allogeneic stem cell transplantation (SCT) in which 45,X/46,XX stem cells derived from donors with mosaic TS were used.Patient 1, a 27-year-old woman, had common acute lymphoblastic leukemia with an abnormal karyotype: 46,X,t(X;22)(p11.3;q12),t(2;16)(p11;q11)[15]/46,XX [5]. She underwent a consolidative allogeneic SCT after a busulfancyclophosphamide (Bu-Cy) conditioning regimen from her phenotypically human leukocyte antigen (HLA)-matched 2.5-year-old daughter.…”

“…Patient 1, a 27-year-old woman, had common acute lymphoblastic leukemia with an abnormal karyotype: 46,X,t(X;22)(p11.3;q12),t(2;16)(p11;q11)[15]/46,XX [5]. She underwent a consolidative allogeneic SCT after a busulfancyclophosphamide (Bu-Cy) conditioning regimen from her phenotypically human leukocyte antigen (HLA)-matched 2.5-year-old daughter.…”

“…A routine cytogenetic study of the marrow at 6 months revealed 45,X[9]/46,XX [11]. To investigate the origin of 45,X cells, the donor's constitutional karyotype was evaluated, confirming a mosaic TS 45,X[15]/46,XX [5]. The disease relapsed at 9 months and cytogenetic analysis revealed 45,X [8]/46,X,t(X;22)(p11.3; q12),t(2;16)(p11;q11) [2]/46,XX [16].…”