Prevalence of Osteoporosis, Osteopenia, and Vertebral Fractures in Long-Term Renal Transplant Recipients

Marcén, R.; Caballero, Carmen; Uriol, O.; Fernandez, Armida; Villafruela, J.J.; Pascual, Julio; Martins, Judith; Rodriguez, N.; Burgos, Francisco; Ortuño, J

doi:10.1016/j.transproceed.2007.07.073

Cited by 34 publications

(26 citation statements)

References 7 publications

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“…We also found that hip and extremity fractures are associated with DCGL, which previously was not shown. This result is consistent with observations of worse graft function among patients with osteoporosis or osteopenia, and it may reflect that good graft function is needed to maintain bone mineral metabolism …”

Section: Discussionsupporting

confidence: 91%

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Salter

Liu

Bae

et al. 2019

J American Geriatrics Society

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OBJECTIVES Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age‐related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death‐censored graft loss (DCGL) and mortality. DESIGN This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014. SETTING We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System. PARTICIPANTS The analytic population included 47 815 KT recipients aged 55 years or older. MEASUREMENTS We assessed the cumulative incidence of and factors associated with post‐KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models. RESULTS The 5‐year incidence of post‐KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5‐y increase; 95% confidence interval [CI] = 1.30‐1.45) and vertebral (aHR = 1.31; 95% CI = 1.20‐1.42) but not extremity (aHR = .97; 95% CI = .91‐1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12‐1.60) and extremity (aHR = 1.30; 95% CI = 1.08‐1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11‐2.52), vertebral (aHR = 2.80; 95% CI = 2.44‐3.21), and extremity (aHR = 1.85; 95% CI = 1.64‐2.10) fracture. CONCLUSION Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680–1688, 2019

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Section: Discussionsupporting

confidence: 91%

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Salter

Liu

Bae

et al. 2019

J American Geriatrics Society

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“…In a study by Marcén et al, performed in 40 RT recipients with stable graft function followed for 10 years after transplantation, it was suggested that the patients with functional grafts had a lower rate of osteoporosis [45]. In accordance, significant bone loss was accompanied with increased creatinine and decreased GFR values indicating poor graft function in both sub-groups of our RT recipients.…”

Section: Discussionsupporting

confidence: 55%

Is Klotho F352V Polymorphism the Missing Piece of the Bone Loss Puzzle in Renal Transplant Recipients?

Özdem

Yılmaz²,

Özdem

et al. 2015

Pharmacology

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Background: Bone disorders are next to cardiovascular problems in frequency in renal transplant (RT) recipients. Reduction in 1,25-dihydroxycholecalciferol (1,25D) levels is among the reasons causing bone loss in these patients. Klotho (KL) serves as a co-receptor for fibroblast growth factor 23 (FGF23), and functions in vitamin D metabolism. KL polymorphisms have been identified in several studies, and phenylalanine to valine substitution at amino acid position 352 seemed to be important to KL function. We investigated KL F352V polymorphism and its relation with 1,25D levels in RT recipients. Methods: The study included 25 RT recipients (8 female, 17 male) and 26 (14 female, 12 male) healthy control subjects who were wild (FF) phenotypes in terms of KL F352V polymorphism. RT recipients with (FV, n = 11) and without (FF, n = 14) a heterozygote polymorphism were determined with high resolution DNA melting analysis of KL F352V polymorphism. Serum 1,25D levels were measured using the RIA method. Results: RT recipients with FV phenotype had significantly lower 1,25D levels (17.58 ± 18.38 pg/ml) compared to recipients with FF phenotype (44.91 ± 24.68 pg/ml) and control subjects (28.24 ± 12.13 pg/ml). 1,25D levels in RT recipients with FF phenotype were significantly higher than control subjects. Conclusions: KL F352V polymorphism may increase the expression of FGF23 co-receptor, KL protein and thus may decrease renal expression of 1α-hydroxylase, and/or stimulate 24-hydroxylase in RT recipients. The resultant decrease 1,25D levels may participate in bone loss in these patients.

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“…Renal transplant patients have an increased prevalence of osteopenia and osteoporosis (1)(2)(3)(4)(5)(6)(7)(8) and an increased risk of fractures (3)(4)(5)(6)(9)(10)(11)(12)(13)(14). This is partly a consequence of previous renal failure with hyperparathyroidism, vitamin D deficiency, acidosis, aluminum toxicity and inactivity (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Can DXA Predict Fractures in Renal Transplant Patients?

Akaberi

Simonsen

Lindergård

et al. 2008

American Journal of Transplantation

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Renal transplant patients have a high prevalence of osteopenia, osteoporosis and fractures. The aim of the study was to investigate whether dual-energy xray absorptiometry (DXA) is of value to predict fractures. In 1995-2007, 238 renal transplant patients underwent 670 DXA investigations. Osteopenia (46.0%), osteoporosis (13.9%) and absolute bone mineral density (BMD) (median 0.9, range 0.4-2.0 g/cm 2 ) in the hip region were used to evaluate fracture risk. Data on fractures were collected at the occasion of each DXA, and a questionnaire was filled in by 191 patients at regular outpatient visits. Reported fractures were verified by consultation of medical records. In all, 46 patients had 53 fractures. Cumulative hazard of fracture was significantly different among normal BMD, osteopenia and osteoporosis in the hip (p < 0.0001). A Cox proportional hazard analysis also including age, gender and diabetic nephropathy showed significantly increased fracture risk for osteoporosis (3.5 times, CI 1.8-6.4, p = 0.0001) as well as for osteopenia (2.7 times, 1.6-4.6, p = 0.0003). A significantly increased risk was also found with absolute BMD estimates below the median. Osteopenia and an absolute bone density below 0.9 g/cm 2 in the hip region confer an increased risk of fracture.

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Prevalence of Osteoporosis, Osteopenia, and Vertebral Fractures in Long-Term Renal Transplant Recipients

Cited by 34 publications

References 7 publications

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients

Is Klotho F352V Polymorphism the Missing Piece of the Bone Loss Puzzle in Renal Transplant Recipients?

Can DXA Predict Fractures in Renal Transplant Patients?

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