The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial.

Ulrich Jehn,Barbara Suwelack,Dirk-Oliver Wennmann,Dennis Görlich,Hermann Pavenstädt,Gerold Thölking,Anja Kortenhorn,Stefan Reuter,Katharina Schütte-Nütgen,Florian Westphal,Markus Strauss

doi:10.3390/jcm11030654

Ulrich Jehn, Barbara Suwelack + Show 9 more

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https://doi.org/10.3390/jcm11030654

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Abstract

Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n = 47), only one (2.2%) patient had previously undergone PTX. After adjusting for the known fracture risk factors MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018–0.991, p = 0.049). We observed a reduced risk for pathological fractures in KTx patients who underwent PTX, independent from elevated parathyroid hormone at the time of KTx or afterwards.

Highlights

IntroductionKidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures, yet their environment combines a number of risk factors that lead to mineral bone disorder (MBD) and osteoporosis
We aimed to clarify the effect of PTX and other factors available for retrospective analysis associated with mineral bone disease (MBD) on osteoporotic bone fractures in
In our larger study with a comparable length of follow-up, the incidence was 10 per 1000 person-years, but unlike the incidental fractures counted by Evenepoel et al, we excluded fractures related to adequate trauma or malignancy

Summary

Introduction

Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures, yet their environment combines a number of risk factors that lead to mineral bone disorder (MBD) and osteoporosis. Since the majority of patients after KTx show impaired renal function/chronic kidney disease (CKD) and present a long history of end-stage renal disease (ESRD), CKDrelated MBD plays an important role in KTx recipients. It refers to CKD-MBD after kidney transplantation. Both high FGF-23 levels and hyperparathyroidism are present post-transplant, contributing to hypophosphatemia and hypercalcemia [2]. Secondary hyperparathyroidism (sHPT) and uremic toxin accumulation enhance osteoclast-mediated bone resorption with increased release of calcium and phosphate [2]

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