How is organ transplantation-related osteoporosis treated?

Updated: Jul 02, 2020
  • Author: Carmel M Fratianni, MD, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Because chronic pain and immobilization from fractures can significantly diminish quality of life, it has been recommended that patients with extremely low bone mass or osteoporotic fractures documented prior to transplantation be counseled about the increased fracture risk that follows transplantation. [83] Since even an entirely normal bone density pretransplantation is not protective against posttransplantation fracture, prophylaxis against bone loss should be given in all transplant recipients, without regard to baseline bone density. [69, 86, 87, 88]

Any patient who meets World Health Organization (WHO) criteria for low bone mass (osteoporosis) should receive pharmacologic treatment similar to any other patient with osteoporosis or osteopenia. There are no specific therapies for posttransplantation osteoporosis approved by the US Food and Drug Administration. Therapeutic strategies are extrapolated from nontransplant situations and based on relatively small numbers of patients in clinical trials. Vitamin D and calcium alone are clearly insufficient to prevent transplant-related bone loss.

The aim of medical therapy should be to prevent bone loss and (if possible) to restore bone lost before transplantation. Guidelines established by the American College of Rheumatology and the UK Consensus Group [84, 89] recommend that patients who receive daily glucocorticoid at doses of 7.5 mg of prednisolone or more for 6 months or longer should begin preventive therapy. Transplant recipients clearly meet this criterion.

Postrenal transplant bone disease reflects the complexity of preexisting renal osteodystrophy, although many aspects of renal osteodystrophy improve with transplantation. Hyperparathyroidism may persist in a subset of patients. [90] Advise all patients to maintain an adequate total elemental calcium intake (ie, 1000-1500 mg) and to take supplements as necessary.

The dose of supplemental calcium should be individualized on the basis of dietary calcium intake, menopausal status, and underlying medical issues. For example, a pharmacologic dose of calcium administered to a renal transplant recipient with persistent secondary hyperparathyroidism could worsen hypercalciuria because of excess PTH action and could be contraindicated.


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