Spontaneous fractures in the renal graft recipient: a discriminant analysis of 144 cases

In a search for factors predisposing to the occurrence of spontaneous fractures in the renal organ transplant patient, a comparison has been made of 38 recipients sustaining spontaneous fractures and 106 without this complication. The comparison was made with regard to the clinical findings, the immunosuppressive therapy given, and the results of the biochemical analyses, all covering the first year after the transplant operation. There were no differences in the clinical findings or the biochemical analyses between the groups. An analysis of the steroid doses showed that, during the first three months after the transplant operation, these were lower for the fracture groups than for the controls (p less than 0.01), as was the case for the oral dose of prednisone, the total dose of all steroids, and the mean daily dose of these drugs in relation to body weight or body surface area. One possible explanation of this unexpected observation is that cortisone in high doses inhibits bone resorption during the period after the transplant operation when secondary hyperparathyroidism is present.