Kidney transplantation: prevention and treatment for bone loss after transplantation

Abstract

Despite the ability of renal transplantation to restore many of the excretory metabolic and hormonal abnormalities of chronic renal failure and dialysis implicated in the development of renal osteodystrophy, osteoporosis remains a frequent and serious complication affecting renal transplant recipients. Short-term studies of bone loss following renal transplantation have indicated rapid bone loss within the first 12 months after transplantation. Cross-sectional data suggest that beyond 3 years after transplantation, the bone mineral density does not change or may increase slightly, but remains less than normal population of reference values. In renal transplant patients, in addition to known risk factors for bone loss in healthy populations, other abnormalities could negatively affected the bone metabolism, including the pretransplant renal osteodystrophy, persistent hyperparathyroidism and use of immunosuppressive drugs. Osteoporosis that is induced by steroid administration is an inevitable side effect and develops more frequently in the elderly recipients. Vitamin D analogues and calcium have beneficial effects in the prevention of glucocorticoid-induced bone loss. Bisphosphonate, which inhibit bone resorption, have been shown in many studies.