Long-term follow-up study on bone mineral density and fractures after simultaneous pancreas-kidney transplantation.
BACKGROUND
In type 1 diabetic patients with end-stage renal failure, low bone mass is prevalent and the incidence of fractures high after simultaneous pancreas kidney transplantation (SPK). Data are scarce on preexisting skeletal morbidity or the long-term effects of SPK on bone mass and risk of fractures.


METHODS
We conducted a prospective study addressing these issues in 19 consecutive SPK recipients before and at 3, 6, and 12 months, and 2.5 to 4 years after establishment of graft function.


RESULTS
Prior to transplantation, 13 patients (68%) had hyperparathyroidism, 7 of whom had osteoporosis. Mean bone mineral density (BMD) was significantly lower at the femoral neck than at the lumbar spine (T-scores -2.0 +/- 0.89 vs. -0.66 +/- 0.84). There was a significant decrease in BMD at both lumbar spine and femoral neck at 6 months post-transplantation (-6.0 +/- 5.4% and -6.9 +/- 4.3%, respectively). No further loss was observed in the following 6 months. At 1 year post-transplantation, 9 patients had osteoporosis associated with hyperparathyroidism in 8, and none had sustained a clinical fracture. A significant albeit small increase in BMD was observed 6 months after start of alfacalcidol 0.25 microg/day. At end-evaluation, osteoporosis and hyperparathyroidism persisted in the patients in whom it was documented at 1 year. Five patients who had lower BMD at the femoral neck pretransplantation sustained a clinical fracture.


CONCLUSIONS
Cortical osteoporosis is prevalent in SPK recipients at the time of transplantation, progresses early post-transplantation, and is associated with relatively high incidence of fractures. Reversal of persistent hyperparathyroidism with the use of alfacalcidol may contribute to a decrease in skeletal morbidity.
Smets
Yves F C
YF
Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands. yfcsmets@lumc.nl
de Fijter
Johan W
JW
Ringers
Jan
J
Lemkes
Herman H P J
HH
Hamdy
Neveen A T
NA
D015519:Bone Density / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003928:Diabetic Nephropathies / Q000209:etiology / Q000378:metabolism; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D006961:Hyperparathyroidism / Q000150:complications / Q000188:drug therapy; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000209:etiology / Q000378:metabolism / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D010024:Osteoporosis / Q000150:complications; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011446:Prospective Studies
D006887:Hydroxycholecalciferols; C008088:alfacalcidol