title: Bone loss after kidney transplantation: a longitudinal study in 115 graft recipients.
abstract: BACKGROUND
  Bone loss is an important problem in renal transplant recipients immediately after surgery. No data are available about the bone loss beyond the first post-transplantation year.
  
  
  METHODS
  In a longitudinal, uncontrolled observational study bone mineral density (BMD) was measured by dual X-ray absorptiometry in 115 renal graft recipients starting at different times after transplantation (0-20 years after transplantation) with a follow-up time of 12 months.
  
  
  RESULTS
  A total of 56 patients showed a reduction of BMD during the observation period. Bone loss depended on the time after transplantation. Mean reduction of BMD at lumbar spine was 7 +/- 10%, 1 +/- 9% during the first and second postoperative year. Beyond the third year bone mineral density did not change or even increased slightly (0 +/- 4% during 3-5th year, 1 +/- 6% during 6-10th year and 2 +/- 4% during 11-20th year after transplantation). Decrease of BMD correlated with a higher mean daily prednisone dosage (P < 0.001), a higher cumulative prednisone dose (P < 0.01), a more frequent and more steroid-resistant rejection (P < 0.001) and a higher initial parathyroid hormone level (P < 0.001). Patients with 25-OH-cholecalciferol therapy (P < 0.05) or more physical activity (P < 0.05) had a smaller bone loss.
  
  
  CONCLUSIONS
  Reduction of BMD after transplantation is highest within the first post-transplant year. The effects of acute graft rejection, prednisone dosage and initial parathyroid hormone level are predominant among the multiple factors associated with pronounced bone loss.
authors.affiliation: Department of Medicine, Albert-Ludwigs-University of Freiburg, Germany.
authors.forename: W H
authors.initials: WH
authors.lastname: Grotz
authors.forename: F A
authors.initials: FA
authors.lastname: Mundinger
authors.forename: J
authors.initials: J
authors.lastname: Rasenack
authors.forename: L
authors.initials: L
authors.lastname: Speidel
authors.forename: M
authors.initials: M
authors.lastname: Olschewski
authors.forename: V M
authors.initials: VM
authors.lastname: Exner
authors.forename: P J
authors.initials: PJ
authors.lastname: Schollmeyer
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D015444:Exercise; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents