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Posttransplant bone disease: a case illustrating dramatic improvements in bone density with vitamin D replacement
R K Dhingra1, S M Sprague, A O Ojo
1Nephrology Division, University of Michigan Medical Center, 315 W. Huron, Ann Arbor, MI 48103-4262.
Transplantation
|July 17, 2001
Summary
Bisphosphonates may not be optimal for all posttransplant bone disease cases. A kidney transplant patient with osteomalacia improved with calcitriol, not bisphosphonates, highlighting the need for diagnostic approaches.
Area of Science:
- Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Bisphosphonates are commonly recommended for posttransplant bone disease.
- However, their efficacy is not universal across all patient presentations.
Observation:
- A kidney transplant recipient presented with hypercalcemia due to extraskeletal calcium mobilization.
- Laboratory findings included low parathyroid hormone and vitamin D, high calcium excretion, and normal calcium intake.
- Bone biopsy confirmed severe osteomalacia.
Findings:
- Bisphosphonates were initially used for hypercalcemia but were inappropriate for treating the underlying osteomalacia.
- Subsequent treatment with oral calcitriol, after serum calcium normalized, led to significant bone density improvements.
- Bone mineral density increased from 63% to 85% at the lumbar spine and 38% to 67% at the femoral neck over two years.
Implications:
- This case demonstrates that an antiresorptive strategy alone is insufficient for certain posttransplant bone diseases.
- Optimal management necessitates a comprehensive diagnostic evaluation to identify all contributing factors.
- Personalized treatment strategies are crucial for effectively managing bone disease in kidney transplant recipients.