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Published on: August 13, 2017
Osseous complications of pediatric transplantation
1Department of Pediatrics, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA. jeff.saland@mssm.edu
Insights
Pediatric solid organ transplant recipients face impaired bone health due to illness and medications. While severe bone disease is less common, long-term risks and osteopenia prevalence require further research and management strategies.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Pediatric Endocrinology
Background:
- Childhood growth and development are crucial for achieving adult stature and peak bone mass.
- Solid organ transplantation in children presents unique challenges to bone health, including chronic illness, pretransplant osteodystrophy, and medication side effects.
- Post-transplant renal dysfunction further complicates bone metabolism in pediatric recipients.
Purpose of the Study:
- To review the impact of solid organ transplantation on bone health in children.
- To discuss the prevalence and challenges in studying bone disease, such as osteopenia, in pediatric transplant recipients.
- To identify potential strategies for optimizing bone health in this population.
Main Methods:
- Literature review focusing on bone health in pediatric solid organ transplant recipients.
- Analysis of factors affecting bone development, including chronic illness, pretransplant conditions, medications, and renal function.
- Discussion of diagnostic challenges related to bone densitometry in children with altered growth patterns.
Main Results:
- Growth delay and short stature are common sequelae.
- Severe bone diseases like fracture and avascular necrosis appear less frequent in pediatric recipients compared to historical data.
- Osteopenia is highly prevalent, though difficult to accurately assess due to methodological limitations.
Conclusions:
- Pediatric transplant recipients face a potential long-term elevated risk of bone disease, similar to adult data.
- Optimal management includes addressing pretransplant osteodystrophy, post-transplant renal insufficiency, judicious steroid use, and calcium/vitamin D supplementation.
- Further research is needed to clarify the role of bisphosphonate therapy in pediatric transplantation.
Abstract:
Adult stature and peak bone mass are achieved through childhood growth and development. Multiple factors impair this process in children undergoing solid organ transplantation, including chronic illness, pretransplant osteodystrophy, use of medications with negative impact on bone, and post-transplant renal dysfunction. While growth delay and short stature remain common, the most severe forms of transplant-related bone disease, fracture and avascular necrosis, appear to have become less common in the pediatric age group. Osteopenia is very prevalent in adult transplant recipients and probably also in pediatrics, but its occurrence and sequelae are difficult to study in these groups due to methodological shortfalls of planar densitometry related to short stature and altered patterns of growth and development. Although the effect on lifetime peak bone mass is not clear, data from adult populations suggest an elevated long-term risk of bone disease in children receiving transplants. Optimal management of pretransplantation osteodystrophy, attention to post-transplant renal insufficiency among both renal and non-renal transplant patients, reduction of steroid dose in select patients, and supplementation with calcium plus vitamin D during expected periods of maximal bone loss may improve bone health. Careful research is required to determine the role of bisphosphonate therapy in pediatric transplantation.
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