title: Bone Disease after Kidney Transplantation.
abstract: Bone and mineral disorders occur frequently in kidney transplant recipients and are associated with a high risk of fracture, morbidity, and mortality. There is a broad spectrum of often overlapping bone diseases seen after transplantation, including osteoporosis as well as persisting high- or low-turnover bone disease. The pathophysiology underlying bone disorders after transplantation results from a complex interplay of factors, including preexisting renal osteodystrophy and bone loss related to a variety of causes, such as immunosuppression and alterations in the parathyroid hormone-vitamin D-fibroblast growth factor 23 axis as well as changes in mineral metabolism. Management is complex, because noninvasive tools, such as imaging and bone biomarkers, do not have sufficient sensitivity and specificity to detect these abnormalities in bone structure and function, whereas bone biopsy is not a widely available diagnostic tool. In this review, we focus on recent data that highlight improvements in our understanding of the prevalence, pathophysiology, and diagnostic and therapeutic strategies of mineral and bone disorders in kidney transplant recipients.
authors.affiliation: Department of Nephrology, Dialysis, and Transplantation, Centre Hospitalier Universitaire de Liege, Liege, Belgium.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bouquegneau
authors.affiliation: Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom; and.
authors.forename: Syrazah
authors.initials: S
authors.lastname: Salam
authors.affiliation: Department of Nephrology, Dialysis, and Transplantation, Centre Hospitalier Universitaire de Liege, Liege, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Delanaye
authors.affiliation: Academic Unit of Bone Metabolism, Metabolic Bone Centre, Northern General Hospital, Sheffield, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.affiliation: Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom; and.
authors.forename: Arif
authors.initials: A
authors.lastname: Khwaja
mesh_terms: D015502:Absorptiometry, Photon; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001847:Bone Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D057966:Calcimimetic Agents / Q000627:therapeutic use; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications; D000069449:Cinacalcet / Q000627:therapeutic use; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008903:Minerals / Q000378:metabolism; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000209:etiology; D010281:Parathyroid Hormone / Q000627:therapeutic use; D014807:Vitamin D / Q000031:analogs & derivatives / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D057966:Calcimimetic Agents; D008903:Minerals; D010281:Parathyroid Hormone; D014815:Vitamins; D014807:Vitamin D; D000069449:Cinacalcet
keywords: Bone Diseases; Metabolic; Osteoporosis; Vitamin D; fibroblast growth factor 23; fracture; glucocorticoids; kidney transplantation; mineral metabolism; parathyroid hormone; renal osteodystrophy