Related Experiment Video
Updated: Aug 8, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Drugs associated with incident fragility fractures in kidney transplant recipients
Benjamin Batteux1,2,3,4, Alban Nowak1, Alice Séjourné3
1Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France.
Background:
The risk of fragility fractures is high in kidney transplant recipients, and steroids are reportedly a major cause. Other drugs known to induce fragility fractures have been studied in the general population but not in kidney transplant recipients. Here, we investigated the association between exposure over time to drugs that can injure bone (namely vitamin K antagonists, insulin, loop diuretics, proton pump inhibitors, opioids, selective serotonin reuptake inhibitors, antiepileptics and benzodiazepines) and incident fractures and changes over time in T-scores in this population.
Methods:
A total of 613 consecutive kidney transplant recipients were included between 2006 and 2019. Drug exposures and incident fractures during the study period were comprehensively documented, and dual-energy X-ray absorptiometry was performed regularly. The data were analyzed using Cox proportional hazards models with time-dependent covariates and linear mixed models.
Results:
Incident fractures occurred in 63 patients, giving a fracture incidence of 16.9 per 1000 person-years. Exposures to loop diuretics [hazard ratio (95% confidence interval) 2.11 (1.17-3.79)] and opioids [5.94 (2.14-16.52)] were associated with incident fractures. Exposure to loop diuretics was associated with a decrease over time in the T-score for the lumbar spine (P = .022) and for the wrist (P = .028).
Conclusions:
This study suggests that the exposure to loop diuretics and opioids increases the risk of fracture in kidney transplant recipients.
Insights
Kidney transplant recipients taking loop diuretics or opioids face a higher risk of fragility fractures. Loop diuretic use also correlated with decreased bone density scores in the spine and wrist.
Area of Science:
- Nephrology
- Pharmacology
- Orthopedics
Background:
- Kidney transplant recipients have a high risk of fragility fractures, with steroids implicated as a major cause.
- Previous studies on bone-injuring drugs focused on the general population, leaving a knowledge gap in transplant recipients.
Purpose of the Study:
- To investigate the association between specific bone-injuring medications and incident fractures in kidney transplant recipients.
- To examine the impact of these drug exposures on bone mineral density (T-scores) over time.
Main Methods:
- A cohort of 613 kidney transplant recipients was followed from 2006 to 2019.
- Drug exposures, incident fractures, and bone density (dual-energy X-ray absorptiometry) were regularly monitored.
- Statistical analysis employed Cox proportional hazards models and linear mixed models.
Main Results:
- The incidence of fractures was 16.9 per 1000 person-years.
- Exposure to loop diuretics (HR 2.11) and opioids (HR 5.94) significantly increased the risk of incident fractures.
- Loop diuretic use was linked to a decline in lumbar spine and wrist T-scores over time.
Conclusions:
- Loop diuretics and opioids are associated with an elevated risk of fracture in kidney transplant recipients.
- These findings highlight the need for careful monitoring of bone health in transplant patients exposed to these medications.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:26Kidney Transplant II: Surgical Procedure
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:16Kidney Transplant III: Nursing Management
01:28Kidney Transplant I: Introduction
01:09Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions
One important factor is the relationship between renal clearance and the apparent volume of distribution. Renal clearance tends to be inversely proportional to the apparent volume of distribution. Drugs with an extensive distribution volume or those...