title: Bone disease in post-transplant patients.
abstract: OBJECTIVE
  Mineral and bone disorders are common problems in organ transplant recipients. Successful transplantation solves many aspects of abnormal mineral and bone metabolism, but the degree of improvement is frequently incomplete. Posttransplant bone disease can affect long-term outcomes as well as increase the likelihood of fracture. In this article, we reviewed the major posttransplant bone diseases and recent advances in treatment strategies.
  
  
  RESULTS
  Pretransplant bone disease and immunosuppressants are important risk factors for posttransplant bone disease. Corticosteroid withdrawal may result in minimal or no protection against fractures, with increased risk for acute rejection. Vitamin D analogue and bisphosphonate are frequently used to prevent and treat posttransplant osteoporosis. Posttransplant hyperparathyroidism increases the risk for all-cause mortality and graft loss, but not major cardiovascular events. Cinacalcet was well tolerated and effectively controlled hypercalcemic hyperparathyroidism; however, it did not improve bone mineral density and discontinuation led to parathyroid hormone rebound. Six-month paricalcitol supplementation reduced parathyroid hormone levels and attenuated bone remodeling and mineral loss in case of posttransplant hyperparathyroidism.
  
  
  CONCLUSIONS
  Posttransplant bone diseases present in various forms, including osteoporosis, hyperparathyroidism, adynamic bone disease, and osteonecrosis. Prophylactic and therapeutic approaches to both pretransplant and posttransplant periods should be considered.
authors.affiliation: aDepartment of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea bDivision of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea cTransplantation Center, Seoul National University Hospital, Seoul, Republic of Korea *Hee Jung Jeon and Hyosang Kim contributed equally to the writing of this article.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Jeon
authors.forename: Hyosang
authors.initials: H
authors.lastname: Kim
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
mesh_terms: D001847:Bone Diseases / Q000209:etiology*; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D007165:Immunosuppression Therapy; D016377:Organ Transplantation / Q000009:adverse effects*; D010020:Osteonecrosis / Q000209:etiology; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors