What is the focus of the clinical history for 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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Answer

Answer

The pretransplant bone evaluation should include a careful history with particular attention to risk factors for osteoporosis. Any personal history of fracture is particularly relevant because prior fracture predicts future fracture. [59] Any family history of osteoporosis or fragility fractures is also relevant. A history of loss of height suggests established osteoporosis and occult thoracic compression fracture.

The review of systems should include a review of gonadal function because a history of amenorrhea, decreased libido, or erectile or orgasmic dysfunction could suggest underlying hypogonadism, predisposing to osteopenia.

The review of systems should specifically inquire about bone pain, myalgias, or myopathic symptoms, which could suggest occult vitamin D deficiency or osteomalacia.

Significant constitutional symptoms or symptomatic anemia could suggest occult multiple myeloma as a cause of osteopenia, in the appropriate clinical context.

Because immobility is known to promote negative bone balance, any history of periods of prolonged bed rest is also relevant.

A careful medication history should be taken for past anticonvulsant use because these medications can derange vitamin D metabolism. Heparin, loop diuretics, and steroids (both oral and inhaled) are associated with negative calcium balance. Any history of tobacco or alcohol abuse is relevant because the use of these substances is an established risk factor for osteoporosis.

A dietary history should be obtained. This should include an estimate of daily calcium intake. An overview of lifelong dairy intake or avoidance, lactose intolerance, malabsorption, or celiac disease, [60] which predispose the patient to vitamin D deficiency, is also relevant. A history of sun avoidance is similarly important. Overall nutritional status, including any prior periods of malnutrition or energy (caloric) restriction (eg, anorexia nervosa) should be assessed.

A history of dietary supplement intake is also relevant. Observational data suggest that excess vitamin A intake (eg, as retinol) is associated with an increased hip fracture risk. [66]


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