Document Detail


Osteoporosis after organ transplantation.
MedLine Citation:
PMID:  9626030     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Within the past 2 decades, organ transplantation has become established as effective therapy for endstage renal, hepatic, cardiac, and pulmonary disease. Regimens to prevent rejection after transplantation commonly include high-dose glucocorticoids and calcineurin-calmodulin phosphatase inhibitors (the cyclosporines and tacrolimus), which are detrimental to bone and mineral homeostasis, and are associated with rapid bone loss that is often superimposed upon an already compromised skeleton. The incidence of fracture ranges from 8% to 65% during the first year after transplantation. In general, fracture rates are lowest in renal transplant recipients and highest in patients who receive a liver transplant for primary biliary cirrhosis. Rates of bone loss and fracture are greatest during the first 6 to 12 months after transplantation. Postmenopausal women and hypogonadal men appear to be at increased risk. Although no pretransplant densitometric or biochemical parameter has yet been identified that adequately predicts fracture risk in the individual patient, low pretransplant bone mineral density does tend to increase the risk of fracture, particularly in women. However, patients may sustain fractures despite normal pretransplant bone mineral density. Although the pathogenesis of the rapid bone loss is multifactorial, prospective biochemical data suggest that uncoupling of bone formation from resorption may be in part responsible, at least during the first 3 to 6 months. Prevention of transplantation osteoporosis should begin well before transplantation. Patients awaiting transplantation should be evaluated with spine radiographs, bone densitometry, thyroid function tests, serum calcium, vitamin D, parathyroid hormone, and testosterone (in men). Therapy for osteoporosis, low bone mass, and potentially reversible biochemical causes of bone loss should be instituted during the waiting period before transplantation. In patients with normal pretransplant bone density, therapy to prevent early posttransplant bone loss should be instituted immediately following transplantation. Most pharmacologic agents available for therapy of osteoporosis have not been subject to prospective controlled studies in organ transplant recipients. However, antiresorptive drugs, such as biphosphonates, appear to hold therapeutic promise.
Authors:
M A Rodino; E Shane
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  The American journal of medicine     Volume:  104     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-25     Completed Date:  1998-06-25     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  459-69     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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MeSH Terms
Descriptor/Qualifier:
Bone Density / drug effects
Bone and Bones / drug effects,  metabolism
Female
Fractures, Bone / chemically induced
Humans
Immunosuppressive Agents / adverse effects*
Incidence
Male
Osteoporosis / chemically induced*,  prevention & control
Risk Factors
Transplantation Immunology*
Grant Support
ID/Acronym/Agency:
AR-41391/AR/NIAMS NIH HHS; RR-006645/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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