Post-Transplantation Osteoporosis

Stein, Emily; Ebeling, Peter R.; Shane, Elizabeth

doi:10.1016/j.ecl.2007.07.008

Cited by 93 publications

(65 citation statements)

References 116 publications

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“…Bone resorption markers are increased in the initial period after transplantation whereas bone formation marker (osteocalcin) is reduced (1). The increase of resorption may be associated with CsA-induced renal insufficiency and resultant secondary hyperparathyroidism.…”

Section: Cardiac Transplantationmentioning

confidence: 95%

“…As advances in immunosuppression therapy and transplant techniques over the last decades have improved allograft and patient survival, new challenges have emerged in the management of long-term complications. Post-transplantation bone disease is a major complication present in most of patients, where low bone mineral density (BMD) increases the risk of fractures and consequently, reduces quality of life and increases mortality (1,2).…”

Section: Introductionmentioning

confidence: 99%

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Bone disease after transplantation: osteoporosis and fractures risk

Kulak

Borba

Kulak

et al. 2014

Arq Bras Endocrinol Metab

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Organ transplantation is the gold standard therapy for several end-stage diseases. Bone loss is a common complication that occurs in transplant recipients. Osteoporosis and fragility fractures are serious complication, mainly in the first year post transplantation. Many factors contribute to the pathogenesis of bone disease following organ transplantation. This review address the mechanisms of bone loss 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 management of bone loss in the transplant recipient should be included in their post transplant follow-up in order to prevent fractures. Arq Bras Endocrinol Metab. 2014;58(5):484-92Keywords Transplantation; bone loss; osteoporosis; fractures; immunosuppressive agents RESUMOTransplantes de órgão é terapia padrão-ouro para várias doenças em estágio terminal. Perda óssea é uma complicação comum que ocorre em pacientes transplantados. Osteoporose e fraturas por fragilidade são complicações sérias, principalmente no primeiro ano pós-transplante. Muitos fatores podem contribuir para patogênese da doença óssea nesses pacientes. Esta revisão aborda os mecanismos de perda óssea incluindo o papel dos agentes imunossupressores, bem como os fatores específicos da perda óssea após rim, pulmão, fígado, coração e transplante de medula óssea. A prevenção e o tratamento da perda óssea nos pacientes transplantados devem ser realizados para evitar fraturas. Arq Bras Endocrinol Metab. 2014;58(5):484-92 Descritores

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Section: Cardiac Transplantationmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Bone disease after transplantation: osteoporosis and fractures risk

Kulak

Borba

Kulak

et al. 2014

Arq Bras Endocrinol Metab

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“…9 Regardless of its mechanisms, there are a few risk factors for allogeneic post-BMT bone loss: glucocorticoid use, high-dose chemotherapy, whole-body irradiation, hypogonadism, GVHD and growth hormone deficiency in children. 10 Besides the classical risk factors there are other possible ones: Rakel et al have recently published a study showing diabetes mellitus as a risk factor for bone fractures in recipients of solid organ transplantation, 11 and increased serum ferritin levels have also been reported as a risk factor for bone fractures in patients with thalassemia. 12 Nevertheless, until the present moment we do not know whether diabetes mellitus or impaired glucose metabolism, and high serum ferritin levels, have some effect in post-BMT osteopenia and osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Low bone mineral density is associated with insulin resistance in bone marrow transplant subjects

Faulhaber

Premaor

Filho

et al. 2009

Bone Marrow Transplant

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Post-BMT subjects have an increased bone fracture risk. Additionally, several factors were associated with osteopenia and osteoporosis in these individuals. We aimed to identify other factors associated with osteopenia and osteoporosis in allogeneic post-BMT subjects. We conducted a cross-sectional study with 47 allogeneic post-BMT subjects. Serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, ferritin, vitamin B 12 , insulin, glucose, cholesterol and triglyceride levels were measured. Insulin resistance and secretion were estimated through the homeostatic model assessment for insulin resistance (HOMA-IR) and homeostatic model assessment for b-cell function (HOMA-B), respectively. A bone densitometry (BMD) was also obtained. The median time after BMT was 47.7 (12-115) months. Osteoporosis was identified in 17.0% of the subjects and osteopenia in 19.7%. The mean serum ferritin (P ¼ 0.002), insulin (Po0.0001), glucose (P ¼ 0.003) and triglyceride (P ¼ 0.018) levels were higher in individuals with osteopenia/osteoporosis. HOMA-IR (Po0.0001) and HOMA-B (Po0.0001) were increased in post-BMT subjects with osteopenia/osteoporosis. There was no other factor associated with the outcome. After adjustments ferritin, serum 25(OH)D and HOMA-IR remained independently associated with osteopenia/osteoporosis; however triglycerides no longer were. In conclusion, in the present study, low serum 25(OH)D levels, high serum ferritin levels and insulin resistance were associated with osteopenia/osteoporosis in post-BMT subjects.

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“…Z-score values of total BMD were significantly lower in patients with graft versus host disease (median -3.86) than others (median -1.16). Patients after autologous HSCT had significantly higher bone mineral density (0.876 ± 0.12 g/cm 2 ) than patients after allogeneic transplantation (0.748 ± 0.04 g/cm 2 ) (p = 0.03). Since the second year after autologous HSCT, bone mineral density (0.991 ± 0.05 g/cm 2 ) was significantly (p = 0.05) higher compared to BMD before this time (0.761 ± 0.06 g/cm 2 ).…”

Section: Resultsmentioning

confidence: 94%

“…Likewise, many children are now surviving HSCT and require structured long-term follow-up care to evaluate risk factors of post-transplantation complications and to provide appropriate prevention and treatment. One of the most frequent long-term complications after HSCT is transplantation bone disease associated with bone turnover abnormalities [2].…”

Section: Introductionmentioning

confidence: 99%