61. Transplantation Osteoporosis

  1. Clifford J. Rosen MD
  1. Peter R. Ebeling

Published Online: 19 JUL 2013

DOI: 10.1002/9781118453926.ch61

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

How to Cite

Ebeling, P. R. (2013) Transplantation Osteoporosis, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition (ed C. J. Rosen), John Wiley & Sons, Inc., Ames, USA. doi: 10.1002/9781118453926.ch61

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9781118453889

Online ISBN: 9781118453926

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Keywords:

  • bone disease;
  • calcineurin inhibitors;
  • glucocorticoids;
  • immunosuppressive therapy;
  • transplantation osteoporosis

Summary

Transplantation is an established therapy for end-stage diseases of the kidney, endocrine pancreas, heart, liver and lung, intestines, and for many hematological disorders. Current immunosuppressive regimens with glucocorticoids and calcineurin inhibitors produce excellent patient and graft survival rates. Both pre-transplantation bone disease and immunosuppressive therapy result in high bone turnover, rapid bone loss, and increased fracture rates, particularly early after transplantation. The bone health of candidates for organ transplantation should be assessed with bone densitometry of the hip and spine. Long-term organ transplant recipients should also have bone mass measurement and treatment of osteoporosis. Oral and intravenous bisphosphonates are the most promising approach for the management of transplantation osteoporosis and reduction of the number of patients with vertebral fractures following transplantation. Active vitamin D metabolites may have additional benefits in reducing hyperparathyroidism, particularly after kidney transplantation.