Nephrol Dial Transplant (1995) 10: 2096-2100
© 1995 European Renal Association-European Dialysis and Transplant Association
research-article
Bone loss after kidney transplantation: a longitudinal study in 115 graft recipients
1Department of Medicine, Albert-Ludwigs-University of Freiburg Freiburg, Germany 2Department of Diagnostic Radiology, Albert-Ludwigs-University of Freiburg Freiburg, Germany 3Department of Biometrics, Albert-Ludwigs-University of Freiburg Freiburg, Germany 4Department of Orthopaedics, Albert-Ludwigs-University of Freiburg Freiburg, Germany
Correspondence and offprint requests to: Correspondence and offprint requests to: Wolfgang Grotz, Department of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
BACKGROUND.: Bone loss is an important problem in renal transplant recipients immediately after surgery. No data are available about the bone loss beyond the first post-transplantation year.
METHODS.: In a longitudinal, uncontrolled observational study bone mineral density (BMD) was measured by dual X-ray absorptiometry in 115 renal graft recipients starting at different times after transplantation (0–20 years after transplantation) with a follow-up time of 12 months.
RESULTS.: A total of 56 patients showed a reduction of BMD during the observation period. Bone loss depended on the time after transplantation. Mean reduction of BMD at lumbar spine was 7±10%, 1±9% during the first and second postoperative year. Beyond the third year bone mineral density did not change or even increased slightly (0±4% during 3–5th year, 1±6% during 6–10th year and 2±4% during 11–20th year after transplantation). Decrease of BMD correlated with a higher mean daily prednisone dosage (P<0.001), a higher cumulative prednisone dose (P<0.01), a more frequent and more steroid-resistant rejection (P<0.001) and a higher initial parathyroid hormone level (P<0.001). Patients with 25-OH-cholecalciferol therapy (P<0.05) or more physical activity (P<0.05) had a smaller bone loss.
CONCLUSIONS.: Reduction of BMD after transplantation is highest within the first post-transplant year. The effects of acute graft rejection, prednisone dosage and initial parathyroid hormone level are predominant among the multiple factors associated with pronounced bone loss.
Keywords: bone mineral density; dual-energy X-ray absorptiometry; kidney transplantation; osteoporosis
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