Chapter

Bone disease in renal transplant recipients

Stuart M. Sprague and Klaus Olgaard

in The Spectrum of Mineral and Bone Disorders in Chronic Kidney Disease

Second edition

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199559176
Published online November 2012 | e-ISBN: 9780191753350 | DOI: http://dx.doi.org/10.1093/med/9780199559176.003.029

Series: Oxford Clinical Nephrology Series

Bone disease in renal transplant recipients

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Even after a successful kidney transplantation with good kidney function, many patients suffer from disabling skeletal symptoms. Ten to 60% of patients may develop a fracture, mainly of the cancellous bones, but also of the vertebrae. Incidence of fractures is greater in female patients and much higher in diabetic kidney transplanted recipients. Furthermore, more than half of kidney transplant recipients develop a significant reduction of the bone mineral content (BMC/BMD), which is mainly manifested in the vertebrae and the hips.

The etiology of the post-transplant bone disease is multifactorial, depending upon the pre-transplant skeletal condition of the patient, upon the immunosuppressive therapy administered after transplantation, upon post-transplant hormonal disturbances and upon the GFR obtained after transplantation. Bone biopsy studies have revealed alterations of bone remodeling that are reflecting a decrease in bone formation despite continuing bone resorption. Prophylaxis and treatment of the post-transplant bone disease should take into consideration the numerous pathogenic factors involved, which might vary significantly from patient to patient. As such, a ‘simple’ and easy to manage protocol to be provided to all post-transplant patients has yet to be developed.

Chapter.  8632 words. 

Subjects: Rheumatology ; Nephrology

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