title: Osteoporosis in the adult solid organ transplant population: underlying mechanisms and available treatment options.
abstract: The prevention and treatment of osteoporosis is an increasingly important topic in the solid organ transplant (SOT) population. Compared to the general population, these patients are at an elevated risk of developing osteoporosis due to progressive disease, lifelong immunosuppressant therapy, and malnutrition. As patients live longer after transplant, chronic disease management is increasingly more important. Supplementation with calcium and vitamin D is often necessary in the SOT population due to a high incidence of vitamin D deficiency. Bisphosphonate therapy is most commonly used for prevention and treatment of osteoporosis, but therapy can be limited by renal dysfunction which is common in transplant recipients. Alternative agents such as teriparatide and calcitonin have not been shown to provide a significant impact on the rate of fractures in this population. Additionally, denosumab may be a promising treatment option due to its novel mechanism of action, and is currently being studied in renal transplant patients. Timely initiation of supplementation and treatment, and minimizing glucocorticoid exposure prior to and after transplantation will aid in the prevention and proper management of osteoporosis in these patients.
authors.affiliation: Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA.
authors.forename: C
authors.initials: C
authors.lastname: Early
authors.affiliation: Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA.
authors.forename: L
authors.initials: L
authors.lastname: Stuckey
authors.affiliation: Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA. tissarah@med.umich.edu.
authors.forename: S
authors.initials: S
authors.lastname: Tischer
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D000069448:Denosumab / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D010024:Osteoporosis / Q000209:etiology* / Q000628:therapy*; D012307:Risk Factors; D019379:Teriparatide / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019379:Teriparatide; D014807:Vitamin D; D000069448:Denosumab; D002116:Calcitonin; D002118:Calcium
keywords: Bisphosphonates; Calcineurin inhibitors; Glucocorticoids; Immunosuppression; Osteoporosis; Transplant