Immunosuppressive therapy and the skeleton

Glucocorticoids and other immunosuppressive drugs, such as cytoclosporine A, are increasingly used today. One of the most common clinical situations in which they are prescribed is for immunosuppression after organ transplantation. These drugs have diverse effects on the skeleton, however, and one of the most common sequelae of organ transplantation is osteoporosis and fractures. Patients treated with immunosuppressive drugs should be carefully evaluated for osteoporosis, preferably prior to or at the time of initiation of immunosuppressive therapy. They should be followed carefully with sequential bone-density measurements and biochemical indices of bone turnover. Measures to prevent bone loss should be initiated early in the course of immunosuppressive therapy.