[Bone metabolism alterations after kidney transplantation].
Early after renal transplantation (RT) a rapid decrease in bone mineral density at the lumbar spine, femoral neck, and femoral shaft has been documented. In addition, an appreciable proportion of patients still remain losing bone late after RT. As a consequence, RT patients are at a high risk of bone fractures as compared to general population. Most fractures involve appendicular skeleton, particularly the feet and ankles, and the diabetic patient is at increased risk of fractures. Thus, early institution of preventive measures and treatment of established osteoporosis are central. The major cause of post-transplantation bone loss is corticosteroid treatment, and this should be used at the lower dose compatible with graft survival. Preexisting hyperparathyroidism also affects the early cancellous bone loss at the spine, and post-transplantation bone loss reflects variable individual susceptibility, resembling the polygenic determination of bone mineral density in general. Clinical trials have demonstrated that bisphosphonates or vitamin D plus calcium supplementation, prevent post-transplantation bone loss during the first 6-12 months. However, their role in preventing bone fractures has not been proven. Finally, recommendations for management, prevention and treatment, are summarized.
Torres
A
A
Servicio de Nefrología, Unidad de Investigación, Hospital Universitario de Canarias, Instituto Reina Sofía de Investigación. atorres@ull.es
García
S
S
Barrios
Y
Y
Hernández
D
D
Lorenzo
V
V
D015502:Absorptiometry, Photon; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000818:Animals; D015415:Biomarkers; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism*; D065095:Calcineurin Inhibitors; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000378:metabolism; D011446:Prospective Studies; D051381:Rats; D006435:Renal Dialysis / Q000009:adverse effects; D012306:Risk; D016559:Tacrolimus / Q000009:adverse effects / Q000494:pharmacology; D014807:Vitamin D / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D065095:Calcineurin Inhibitors; D004164:Diphosphonates; D004232:Diuretics; D007166:Immunosuppressive Agents; D014807:Vitamin D; D002118:Calcium; D016559:Tacrolimus