What is the role of tacrolimus in the pathogenesis of organ transplantation-related osteoporosis?

Updated: Jul 02, 2020
  • Author: Carmel M Fratianni, MD, FACE; Chief Editor: George T Griffing, MD  more...
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Tacrolimus is a fungal macrolide that is less nephrotoxic and more potently immunosuppressive than CsA. In rats, this has been reported to cause high-turnover bone loss of even greater magnitude than that caused by CsA. [59, 60] Because tacrolimus is a more potent immunosuppressant, steroid doses may be reduced further with tacrolimus than with CsA.

A study in liver transplant recipients by Smallwood et al showed a nonsignificant tendency toward fewer patients with low bone density in the group receiving tacrolimus (n=112) compared with those receiving cyclosporine (n=25). Among the patients weaned from prednisone, the patients treated with tacrolimus were less likely to have low BMD (36.2% vs 68.8%). [61] Overall, rates of bone loss have been similar in heart, liver, and kidney transplant recipients receiving either tacrolimus or CsA.

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