Evaluation and management of bone disease following renal transplantation

Abstract

Purpose of review Bone disease is a common problem after renal transplantation. Interventions to alleviate bone disease such as bisphosphonates and vitamin D analogues are widely available and are increasingly used in the transplant population. This article reviews the literature published within the past 12 months regarding the assessment and treatment of bone disease in renal transplant recipients. Recent findings Recent literature details new diagnostic approaches to identifying patients with bone fragility including quantitative ultrasound and computed tomography. Recent randomized, controlled trials examine the use of vitamin D and analogues (n = 2) and alendronate (n = 1) to prevent bone disease in renal transplantation. Two observational studies of the use of cinacalcet to treat posttransplant hyperparathyroidism have become available and randomized trials are awaited. Summary There continues to be a paucity of evidence that intervention for bone disease in the renal transplant population achieves a reduction in fracture events, and treatment remains associated with cost and toxicity. The diagnostic utility of radiology and bone histomorphometry to identify patients most at risk of transplant-related fracture also remains imprecise.