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Osteoporosis after solid organ or stem cell transplantation

Elizabeth Shane, MD
Harold N Rosen, MD
Section Editors
Peter J Snyder, MD
Marc K Drezner, MD
Deputy Editor
Jean E Mulder, MD


Transplantation has become an established therapy for end-stage kidney, heart, lung, and liver diseases, as well as for several hematologic disorders. Improved survival of transplant recipients has raised awareness of post-transplant complications, such as osteoporosis. Post-transplant osteoporosis and fracture occur in a substantial proportion of patients.

The pathogenesis, clinical manifestations, and management of bone loss after solid organ (with the exception of renal transplant) or stem cell transplantation will be reviewed here. Management of bone loss after renal transplantation is discussed elsewhere. (See "Persistent hyperparathyroidism after renal transplantation".)


Transplant-related osteoporosis and fracture are due to both pretransplant and post-transplant factors (table 1).

Pretransplant bone status — Many patients undergoing transplantation already have low bone mineral density (BMD). The mechanism appears to vary with the underlying disease:

In patients with severe heart failure (New York Heart Association [NYHA] classes III and IV) who are candidates for cardiac transplantation, chronic kidney disease, vitamin D deficiency, secondary hyperparathyroidism, hypogonadism, chronic use of heparin and/or loop diuretics, and reduced physical activity may contribute to low BMD [1].


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Literature review current through: Sep 2016. | This topic last updated: Jul 7, 2014.
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