Osteoporosis after solid organ and bone marrow transplantation.
Organ transplantation has become increasingly common as a therapy for end-stage renal, liver, cardiac and pulmonary disease. The population of patients who have survived organ transplantation has grown dramatically over the last 2 decades. Although organ transplant recipients now benefit from greatly improved survival, long-term complications of organ transplantation, such as osteoporosis, adversely affect quality of life and must be addressed. In the early post-transplantation period, the effects of high dose glucocorticoids, combined with other immunosuppressive drugs such as cycosporine A and tacrolimus, cause rapid bone loss particularly at the spine and proximal femur. In this setting, fracture incidence rates as high as 25-65% have been reported. Treatment and prevention strategies must target this early post-transplant period, as well as the patient awaiting transplantation and the long-term transplant recipient. This review will discuss the clinical features of transplantation osteoporosis, the pathophysiology of post-transplantation bone loss and prevention and therapy of this unique bone disease.
Cohen
Adi
A
College of Physicians & Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA.
Shane
Elizabeth
E
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016377:Organ Transplantation / Q000009:adverse effects*; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control
D007166:Immunosuppressive Agents