What is the role of bone densitometry in the workup 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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Answer

Answer

Bone densitometry measurements by dual energy x-ray absorptiometry (DEXA) scanning of the LS spine and hips should be performed on all patients prior to transplantation.

DEXA scanning should be performed not only to screen for preexisting bone loss in this medically ill population predisposed to osteoporosis but also to establish a baseline in patients who will require long-term administration of glucocorticoids as part of an immunosuppressive posttransplantation regimen. [83]

Guidelines established by the American College of Rheumatology and the UK Consensus Group recommend that patients receiving daily glucocorticoid at doses of 7.5 mg or more of prednisolone for 6 months or longer should have a BMD measurement. [84]

Bone density of the distal radius should also be measured in patients with renal osteodystrophy and any evidence of hyperparathyroidism.

The Kidney Disease Outcomes Quality Initiative has recommended a DEXA scan at time of renal transplantation by DEXA to assess for the presence of development of osteoporosis. [85] DEXA scans are recommended at time of transplantation and 1 and 2 years following transplantation. Parenteral bisphosphonate should be considered when BMD t -score is less than or equal to –2 standard deviation.


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