Transplantation osteoporosis

Improved survival rates necessitate a greater awareness of long-term complications of transplantation such as fractures and osteoporosis. Patients with chronic kidney disease who have low bone mineral density (BMD) and bone turnover markers in the upper half of the normal premenopausal range are at the highest risk of fracture. Osteoporotic BMD affects up to 40% of patients with congestive heart failure, with a 2.5-fold increase in fracture risk. Low body mass index before liver transplant, cholestatic liver disease and older age are important risk factors for osteoporosis. Bone loss in stem cell transplantation (SCT) recipients is related both to the underlying diseases and to chemotherapeutic drugs. Glucocorticoids exposure varies with the organ transplanted and the number of rejection episodes. Preventive therapy initiated in the immediate posttransplantation period is indicated in patients with osteopenia or osteoporosis, because further bone loss will occur immediately after transplantation.