title: Reduced fracture risk with early corticosteroid withdrawal after kidney transplant.
abstract: Corticosteroid use after kidney transplantation results in severe bone loss and high fracture risk. Although corticosteroid withdrawal in the early posttransplant period has been associated with bone mass preservation, there are no published data regarding corticosteroid withdrawal and risk of fracture. We hypothesized lower fracture incidence in patients discharged from the hospital without than with corticosteroids after transplantation. From the United States Renal Data System (USRDS), 77, 430 patients were identified who received their first kidney transplant from 2000 to 2006. Fracture incidence leading to hospitalization was determined from 2000 to 2007; discharge immunosuppression was determined from United Networks for Organ Sharing forms. Time-to-event analyses were used to evaluate fracture risk. Median (interquartile range) follow-up was 1448 (808-2061) days. There were 2395 fractures during follow-up; fracture incidence rates were 0.008 and 0.0058 per patient-year for recipients discharged with and without corticosteroid, respectively. Corticosteroid withdrawal was associated with a 31% fracture risk reduction (HR 0.69; 95% CI 0.59-0.81). Fractures associated with hospitalization are significantly lower with regimens that withdraw corticosteroid. As this study likely underestimates overall fracture incidence, prospective studies are needed to determine differences in overall fracture risk in patients managed with and without corticosteroids after kidney transplantation.
authors.affiliation: Penn State School of Medicine at Hershey, PA, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Nikkel
authors.forename: S
authors.initials: S
authors.lastname: Mohan
authors.forename: A
authors.initials: A
authors.lastname: Zhang
authors.forename: D J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: S
authors.initials: S
authors.lastname: Boutroy
authors.forename: G
authors.initials: G
authors.lastname: Dube
authors.forename: B
authors.initials: B
authors.lastname: Tanriover
authors.forename: D
authors.initials: D
authors.lastname: Cohen
authors.forename: L
authors.initials: L
authors.lastname: Ratner
authors.forename: C S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: M B
authors.initials: MB
authors.lastname: Leonard
authors.forename: E
authors.initials: E
authors.lastname: Shane
authors.forename: T L
authors.initials: TL
authors.lastname: Nickolas
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000139:chemically induced* / Q000517:prevention & control*; D006084:Graft Rejection / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents; D007674:Kidney Diseases / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents