Presented in abstract form at the American Society of Bone and Mineral Research meeting, Cincinatti, Ohio, U.S.A., 1997, and at the National Osteoporosis Society Meeting, Bath, United Kingdom, 1998.
Cross-Sectional Analysis of Renal Transplantation Osteoporosis†
Article first published online: 1 NOV 1999
Copyright © 1999 ASBMR
Journal of Bone and Mineral Research
Volume 14, Issue 11, pages 1943–1951, November 1999
How to Cite
Parker, C. R., Freemont, A. J., Blackwell, P. J., Grainge, M. J. and Hosking, D. J. (1999), Cross-Sectional Analysis of Renal Transplantation Osteoporosis. J Bone Miner Res, 14: 1943–1951. doi: 10.1359/jbmr.19126.96.36.1993
- Issue published online: 2 DEC 2009
- Article first published online: 1 NOV 1999
- Manuscript Accepted: 23 JUN 1999
- Manuscript Revised: 12 MAR 1999
- Manuscript Received: 2 DEC 1998
We report a cross-sectional study of 54 adult female renal transplant recipients. We measured bone mineral density (BMD) of the lumbar spine, femoral neck, total hip, and mid- and total radius, and 38 patients underwent transiliac crest bone biopsy. Osteopenia was widespread with 31/54 (57%) of patients osteoporotic at one or more sites. Seventeen out of 54 (32%) of the patients had a prevalent low-trauma fracture. There was a clear trend in BMD reduction across spine, hip and midradius, with the predominantly cortical midradial site showing the greatest loss. We found no relationship between BMD and body mass index, parathyroid hormone (PTH), dose of immunosuppressant, years since transplantation, age at menopause, or years since menopause. Histologically, abnormal biopsies could be classified into three categories: hyperparathyroid (n = 20), adynamic (n = 14), and osteomalacic (n = 2). Mean PTH was lower (p = NS) and mean cumulative prednisolone dose was higher (p = 0.04) in the adynamic group compared with the hyperparathyroid group, but because of overlap between groups neither was an effective discriminator of histology. We suggest that bone biopsy is indicated in these patients to direct appropriate treatment. At the cellular level, there were significant negative correlations between osteoclast function (eroded surface, r = 0.47, p = 0.003) and osteoblast numbers (osteoblast surface, r = –0.40, p = 0.01) and cumulative exposure to prednisolone. We postulate that suppression of osteoblast function by prednisolone with unopposed bone resorption may result in relative hypercalcaemia and low PTH. This progressive reduction in bone turnover may promote or prolong the adynamic state.