Chapter 23 - Management: Prevention of Bone Loss after Organ Transplantation

Abstract

This chapter focuses on the primary prevention of rapid early bone loss after transplantation. There are a number of agents that are effective in the prevention of post-transplantation bone loss of various organs. Further clinical trials are necessary to establish the comparative efficacy of different agents, but some form of primary prophylaxis for osteoporosis should be considered in patients undergoing organ transplantation. Bisphosphonates are the most effective agents for the prevention and treatment of posttransplantation osteoporosis. Prophylaxis should involve a bisphosphonate with active vitamin D metabolites as second line or adjunctive therapy. A potential reduction in immunosuppressive requirements with active vitamin D metabolites is an additional consideration, but hypercalcemia and hypercalciuria also become relatively common. Testosterone replacement should be reserved for men with true hypogonadism post-transplant. Patients who are receiving anti-osteoporosis therapy prior to transplantation can theoretically experience less bone loss after transplantation, but whether drug therapy for osteoporosis before transplantation reduces bone loss and fracture risk after transplantation is currently unclear.