Osteoporosis in transplant recipients: recommendations for avoidance and therapy

Osteoporosis is a frequent and severe complication of transplantation that substantially reduces the recipient's quality of life. However, strategies to prevent or to treat osteoporosis have as yet not been established. Determination of bone mass and density is the basis for interventions following transplantation. Therefore, bone mineral density should be measured in all patients awaiting transplantation to assess their individual risk of fracture. Prophylaxis should be considered in patients at high risk in view of the rapid initial bone loss after transplantation. Treatment of acute rejection with corticosteroids induces more bone loss than maintenance therapy with corticosteroids. Once manifest osteoporosis has occurred, treatment with a triple therapy consisting of calcium, vitamin D and either calcitonin or bisphosphonates is possible without negative effects on graft function. Therapy should be initiated according to the general guidelines for osteoporosis therapy, but several aspects specific for this patient group have to be considered. The present recommendations for the management of osteoporosis after transplantation need to be proven by further intervention studies.