Bone loss after renal transplantation: role of hyperparathyroidism, acidosis, cyclosporine and systemic disease

Publisher Website
Google Scholar
Abstract
In order to determine risk factors for bone loss after renal transplantation, dual energy X-ray absorptiometry was performed in 125 renal transplant patients. The bone mineral density (BMD) was expressed as a percentage of the normal population (BMD%) and Z-score (SD from normal). The whole body, lumbar spine and femoral neck BMD% (Z-score) values were 93.9±8.9 (−0.90 SD), 91.6±14.9 (−0.98 SD) and 87±15.3 (−1.0 SD)%, respectively. Low BMD% was associated with low creatinine clearance (40 mL/min: 95.6±8.0, p1: 87.4±9.3, p<0.05), long dialysis duration (5: 90.1±10.6, p<0.05), acidosis (bicarbonate 27: 96.7±7.2, p<0.01), secondary and tertiary hyperparathyroidism (200: 87.7±5.0, p<0.01), raised alkaline phosphatase (300: 85.6±13.2, p<0.001), osteocalcin (100: 89.3±7.6, p<0.01) and urinary deoxypyridinoline (10: 82.1±20.1, p<0.05), low 25-OH-vitamin D (20: 96.9±7.4, p150: 92.1±9.3, p<0.05). Patients with clinical atherosclerosis (91.7±8.6 vs. 95.4±8.8, p<0.01), hypoalbuminemia (550: 94.2±7.8, p<0.01), renovascular disease (89.7±5.7 vs. 95.0±5.7, p<0.05) and diabetic nephropathy (femoral neck 76.6±8.8 vs. 89.3±15.1, p3 μg/wk: 97.3±6.9, p<0.05). No relationships with transplantation duration, 1,25-OH-vitamin D, aluminium, calcium or steroid dose were found. No involutional changes in tertiary hyperparathyroidism could be discerned. Conclusion. The major threats to bone mass after renal transplantation appear to be ongoing hyperparathyroid bone disease, low renal function, acidosis, systemic disease and hypo-vitaminosis D.