Transplantation Osteoporosis

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.