Osteoporosis After Transplantation

Abstract

Transplantation is an established therapy for end-stage diseases of kidney, lung, liver, and heart among others. Osteoporosis and fragility fractures are serious complications of organ transplantation, particularly in the first post-transplant year. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. This review addresses the mechanisms of bone loss that occurs both in the early and late post-transplant periods, including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac, and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient are also discussed.

Guidelines for the diagnosis, prevention and management of osteoporosis

“…These data are not surprising when considering the many factors that contribute, in most subjects with end-stage renal disease, to the development of renal osteodystrophy, i.e., a condition characterised by a range of bone disorders (Table IX) and known for inducing extreme bone fragility. Epidemiological data on organ transplant are less accurate, due to the relatively small number of patients included in available studies (67,68). However, it is known that the estimated prevalence of fragility fractures is approximately 10-15% among subjects waiting for solid organ transplantation (kidney, heart, liver, lung), due to the negative effects of the underlying disease on bone.…”

“…The proportion of patients with osteoporosis increases dramatically after transplantation. Bone loss is maximal in the first year after transplantation and may persist afterwards, although at a slower rate (67)(68)(69). After transplantation, more than 10% and approximately 50% of subjects with renal disease experience fragility fractures in the appendicular skeleton and vertebral fractures, respectively.…”

Update on lung transplantation: programmes, patients and prospects

“…In older LTR, cardiovascular complications are also common and include diastolic dysfunction, coronary artery disease, atrial fibrillation particularly in the perioperative transplant period and, later on, systemic hypertension and hyperlipidaemia [307]. Other significant complications that can be exacerbated by routine posttransplant medications include myelosuppression [308], glucose intolerance and diabetes [309], electrolyte disorders, gonadal dysfunction and osteoporosis [310][311][312].…”

“…Similarly, the high prevalence of osteopaenia and osteoporosis in patients with advanced lung disease (especially in those with low body mass index and chronic steroid use) and LTx was well recognised from the beginning. More recently, there has been an increasing interest in identifying different patterns of bone loss (as defined by bone densitometry) in the setting of posttransplant immunosuppression but ''adequate'' vitamin D, calcium and bisphosphonate therapy and then relating this information to overall bone strength and the development of fractures [311,[334][335][336].…”

“…Similarly, osteoporosis is a common clinical problem after LTx [424]. This is thought to reflect the intersection of direct effects of immune suppressing therapies, not restricted to steroids, to repress new bone formation together with the pro-osteoclastic effect of lung inflammation which is known to induce bone resorption.…”