[Bone metabolism alterations after kidney transplantation]

Area of Science:

• Nephrology
• Endocrinology
• Orthopedics

Background:

• Renal transplantation (RT) is associated with rapid bone mineral density loss.
• RT patients face a higher risk of fractures, especially in the appendicular skeleton.
• Diabetic patients undergoing RT have an even greater fracture risk.

Purpose of the Study:

• To summarize the causes and consequences of bone loss after renal transplantation.
• To review preventive measures and treatments for post-transplantation bone loss and osteoporosis.
• To provide management recommendations for bone health in RT recipients.

Main Methods:

• Review of clinical trials and existing literature on bone mineral density after RT.
• Analysis of factors contributing to bone loss, including corticosteroid use and hyperparathyroidism.
• Evaluation of the efficacy of bisphosphonates and vitamin D/calcium supplementation.

Main Results:

• Significant bone mineral density decrease occurs early and can persist late after RT.
• Corticosteroid treatment is a major cause of post-transplantation bone loss.
• Bisphosphonates or vitamin D/calcium prevent bone loss in the first 6-12 months post-RT, but fracture prevention is unproven.

Conclusions:

• Early intervention and treatment of osteoporosis are crucial for RT patients.
• Minimizing corticosteroid dosage and managing hyperparathyroidism are key strategies.
• While supplements can prevent bone loss, their role in fracture prevention requires further investigation.