Impact of corticosteroid withdrawal on bone mineral density after kidney transplantation

Bone abnormalities are common after kidney transplantation (KTx) and are associated with an increased risk of fractures. The pathophysiology of post-KTx bone disorders is multifactorial, with corticosteroid (CS) therapy being a contributor to the loss of bone mineral density (BMD). This study aimed to evaluate the impact of CS withdrawal versus continued CS therapy on BMD evolution in a kidney transplant recipients (KTRs) cohort.

We retrospectively analyzed BMD data from 132 patients who underwent KTx between 2005 and 2021. BMD was assessed using dual-energy X-ray absorptiometry at the time of KTx (T0) and two-years post-KTx (2yT). Patients were categorized into two groups: those who discontinued CS (CS-) within the first-year post KTx and those who continued CS therapy (CS+).

The mean age at KTx was 52.2 (± 12.6) years, and 62.1% of the patients were male. Overall, BMD increased significantly at the lumbar spine (LS) but decreased at the radius at 2yT, while BMD at the hip site remained stable. CS was discontinued in 44.7% of patients between T0 and 2yT, with an average discontinuation time of 6.3 (± 4.9) months post-KTx. The CS- group showed significant BMD improvements at LS and hip sites. In a multivariate analysis, a higher cumulative CS dose was independently associated with a larger BMD decline.

CS withdrawal after KTx positively impacts BMD, while higher cumulative CS doses are associated with a greater BMD loss. These findings underscore the importance of minimizing CS exposure to preserve bone health in KTRs.