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Bone fractures after cardiac transplantation
M Luaces1, M G Crespo Leiro, M J Paniagua Martin
1Fuenlabrada University Hospital, Cardiología, Fuenlabrada, Spain. mluaces.hflr@salud.madrid.org
Insights
Heart transplant recipients experienced a low rate of bone fractures, particularly postmenopausal women and overweight individuals. Tacrolimus-based immunosuppression was linked to fewer fractures, highlighting its potential role in bone health post-transplant.
Area of Science:
- Orthopedics
- Transplantation Medicine
- Pharmacology
Background:
- Bone loss and fractures are significant complications following heart transplantation, primarily occurring within the first year.
- Steroids and cyclosporine negatively impact bone metabolism, necessitating antiresorptive therapies.
Purpose of the Study:
- To determine the incidence of bone fractures in heart transplant recipients.
- To analyze the influence of pre-existing comorbidities, immunosuppressive regimens, and osteoprotective treatments on fracture occurrence.
Main Methods:
- A cohort of 443 heart transplant recipients was retrospectively analyzed from 1993 to 2005.
- Data collected included fracture occurrence, immunosuppressive therapy details, clinical conditions, and antiresorptive treatment administration.
Main Results:
- A total of 41 fractures (7.6%) were observed in 34 patients. Lumbar spine fractures were most common.
- Postmenopausal women (20.6%) and overweight patients (61.8% incidence) showed higher fracture rates.
- Initial immunosuppression with tacrolimus was associated with a significantly lower fracture incidence (P = .01).
Conclusions:
- The study indicates a low overall frequency of bone fractures after heart transplantation.
- Risk factors for fractures include being postmenopausal or overweight.
- Utilizing tacrolimus as an initial immunosuppressive agent may reduce fracture rates in this patient population.
Objective:
Bone loss and bone fractures are disabling complications after heart transplantation. Severe bone loss happens mainly during the first year posttransplantation. Steroids and cyclosporine alter bone metabolism in several ways. To counterbalance these effects, antiresorptive therapy is provided to these patients. The objective of this study was to assess the frequency of bone fractures after heart transplantation, considering previous comorbidities, immunosuppressive therapy, and osteoprotective treatment.
Methods:
From 1993 to 2005, 443 consecutive heart transplant recipients were followed for the occurrence of bone fractures, immunosuppressive therapy, clinical conditions, and antiresorptive treatment.
Results:
There were 41 fractures in 34 patients (7.6%, group I). The remainder of patients formed group II. Fractures commonly involved the lumbar spine. Postmenopausal women had more fractures than other patients (20.6% vs 7.8%, P = .02). When the initial immunosuppressive regimen included tacrolimus, fractures did not happen (P = .01, vs other regimens). Osteoprotective therapy was administered to 91.2% of patients in group I and 79% in group II (P = .08). Mean interval from transplantation to the first fracture was 1131.5 days. Overweight patients had a 61.8% incidence of fracture.
Conclusions:
Our series showed a low frequency of bone fractures. Postmenopausal women and overweight patients had more fractures. An initial immunosuppressive regimen using tacrolimus was associated with lower fracture rates.
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