Osteoporosis after kidney transplant

Abstract

Background: Osteoporosis is a prevalent complication in kidney transplant recipients, primarily due to the effects of immunosuppressive therapy and pre-existing bone mineral disorders associated with chronic kidney disease (CKD). This study aimed to assess changes in bone mineral density (BMD), the incidence of fractures, and the effectiveness of treatments in managing post- transplant osteoporosis. Method: A 12-month retrospective cohort study examined 100 kidney transplant patients. DXA was used to evaluate BMD at the lumbar spine, femoral neck, and whole hip at baseline (pre-transplant) and 6 and 12 months’ post-transplant. Fracture incidence, corticosteroid usage, vitamin D levels, immunosuppressive medication, and osteoporosis therapies (bisphosphonates, vitamin D) were recorded. Changes in BMD, fracture risk, and therapy efficacy were analysed statistically. Results: Significant reductions in BMD were observed within the first year post-transplant, with an 8% decrease at the lumbar spine and a 6% decrease at the femoral neck. Fractures occurred in 8% of patients, primarily vertebral and hip fractures, with higher rates in those receiving higher cumulative corticosteroid doses and those with lower baseline vitamin D levels. Patients receiving bisphosphonates and vitamin D supplementation had better BMD retention and a lower fracture incidence compared to untreated patients. Conclusion: In the initial year after transplantation, kidney transplant recipients are at risk for fast bone loss and fractures. Immunosuppressive medication, notably corticosteroids, causes BMD loss. Bisphosphonates and vitamin D treatment reduced this risk. Future studies are needed to assess the long-term advantages of osteoporosis therapies in kidney transplant patients.