Abstract
PurposeOsteoblasts and adipocytes are derived from mesenchymal stem cells. An imbalance in the differentiation of these lineages could affect the preservation of bone integrity. Several studies have suggested the importance of this imbalance in the pathogenesis of osteoporosis after kidney transplant (KT), but the role of bone marrow adiposity in this process is not well known, and if the treatment with the anti-absorptive (zoledronic acid-ZA) drugs could attenuate bone loss. Thus, our objective was compare bone marrow adiposity, osteoblasts and osteocytes before and after KT, verify an association between bone remodeling process (Turnover, Volume, and Mineralization—TMV classification), the osteocyte sclerostin expression to evaluate if there is a role of Wnt pathway, as well as the effect of ZA on these cells.MethodsWe studied 29 new living-donor KT patients. One group received ZA at the time of KT plus cholecalciferol for twelve months, and the other group received only cholecalciferol. Bone biopsies were performed at baseline and after 12 months of treatment. Histomorphometric evaluation was performed in bone and bone marrow adipocytes. Sclerostin (Scl) expression in osteocytes was evaluated by immunohistochemistry.ResultsSome bone marrow adiposity parameters were increased before KT. After KT, some of them remained increased and they worsened with the use of ZA. In the baseline, lower bone Volume and Turnover, were associated with increased bone marrow adiposity parameters (some of them). After KT, both groups showed the same associations. Osteocyte Scl expression after KT decreased with the use of ZA. We observed also an inverse association between bone adiposity parameters and lower osteocyte sclerostin expression 12 months after KT.ConclusionIn conclusion, the present study suggests that KT fails to normalize bone marrow adiposity, and it even gets worse with the use of ZA. Moreover, bone marrow adiposity is inversely associated with bone Volume and Turnover, which seems to be accentuated by the antiresorptive therapy.
Highlights
Patients with advanced chronic kidney disease (CKD) can be treated with dialysis or renal transplantation
Some bone marrow adiposity parameters were increased before kidney transplant (KT)
The present study suggests that KT fails to normalize bone marrow adiposity, and it even gets worse with the use of zoledronic acid (ZA)
Summary
Patients with advanced chronic kidney disease (CKD) can be treated with dialysis or renal transplantation. Present since the early stages of CKD, lead to biochemical alterations of calcium, phosphorus, parathormone, FGF-23 and vitamin D, in addition to abnormalities in remodeling, mineralization, volume and bone resistance, as well as development of vascular calcifications [2,3]. These disorders are responsible for numerous complications, among them fractures, and increased morbidity and mortality of the patients affected. This loss is due to the use of immunosuppressants, especially corticosteroids [4,5]
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