title: Bone disease after renal transplantation.
abstract: Bone disease is common after renal transplantation. The main syndromes are bone loss with a consequent fracture rate of 3% per year, osteonecrosis of the hip, and bone pain. The causes of disease include preexisting uremic osteodystrophy (hyperparathyroidism, aluminum osteomalacia, beta2-associated amyloidosis, and diabetic osteopathy), postoperative glucocorticoid therapy, poor renal function, and ongoing hyperparathyroidism, as the result of either autonomous transformation of the parathyroid gland or ongoing physiologic stimuli. Cyclosporine A treatment, hyperphosphaturia, and a pathogenic vitamin D allele have also been implicated. Bone loss is particularly pronounced during the first year after operation, amounting to up to 9% of bone mass. The clinical and biochemical picture is consistent with a high turnover bone disease, but histomorphometric studies do not completely support this. Principal prophylactic options include preoperative osteodystrophy prophylaxis; postoperative calcium, vitamin D, or calcitriol therapy; estrogen therapy for postmenopausal women; and parathyroidectomy for medically intractable hyperparathyroidism. Recently, prophylactic biphosphonate treatment has shown promise, but the exact indications for treatment remain to be determined.
authors.affiliation: Department of Nephrology B, Copenhagen University Hospital in Herlev, Denmark. heaf@dadlnet.dk
authors.forename: James G
authors.initials: JG
authors.lastname: Heaf
mesh_terms: D001847:Bone Diseases / Q000209:etiology*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation; D011183:Postoperative Complications