Bone disease in organ transplant patients: pathogenesis and management.
Bone disease is common in recipients of kidney, heart, lung, liver, and bone marrow transplants, and causes debilitating complications, such as osteoporosis, osteonecrosis, bone pain, and fractures. The frequency of fractures ranges from 6% to 45% for kidney transplant recipients to 22% to 42% for heart, lung, and liver transplant recipients. Bone disease in transplant patients is the sum of complex mechanisms that involve both preexisting bone disease before transplant and post-transplant bone loss due to the effects of immunosuppressive medications. Evaluation of bone disease should preferably start before the transplant or in the early post-transplant period and include assessment of bone mineral density and other metabolic factors that influence bone health. This requires close coordination between the primary care physician and transplant team. Patients should be stratified based on their fracture risk. Prevention and treatment include risk factor reduction, antiresorptive medications, such as bisphosphonates and calcitonin, calcitriol, and/or gonadal hormone replacement. A steroid-avoidance protocol may be considered.
Division of Nephrology, Department of Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USA. veeraish.chauhan@drexelmed.edu
Veeraish
V
Chauhan
Karthik M
KM
Ranganna
Nishtha
N
Chauhan
Megha
M
Vaid
Ellie
E
Kelepouris
D015519:Bone Density; D001847:Bone Diseases / Q000209:etiology* / Q000517:prevention & control*; D002116:Calcitonin / Q000627:therapeutic use; D002117:Calcitriol / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects; D020249:Hormone Replacement Therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors
D004164:Diphosphonates; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D002116:Calcitonin; D002117:Calcitriol