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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 posttransplant complications, such as osteoporosis. Posttransplant 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 "Bone disease after renal transplantation" and "Persistent hyperparathyroidism after renal transplantation".)


Incidence — Osteoporosis and fracture frequently occur after solid organ or hematopoietic transplantation [1]. In the past, fracture incidence rates ranging from 10 to 65 percent were reported (eg, 10 to 36 percent after heart transplantation and 24 to 65 percent after liver transplantation) [2-5]. However, in some studies, the rate of posttransplant fracture is decreasing, in part due to increased recognition of the problem, which has resulted in changes in immunosuppressive regimens (reduction in dose and duration of glucocorticoids), earlier treatment for osteoporosis, and improvement in pre- and posttransplantation nutrition [6,7].

As an example, in a retrospective review of 531 records from 592 eligible patients undergoing liver transplantation at a single center between 1998 and 2008, following the introduction of a protocol for bone health assessment and management, posttransplant fractures occurred in 3.5 percent [6].

Risk factors — Transplant-related osteoporosis and fracture are due to both pre- and posttransplant factors (table 1).

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Literature review current through: Nov 2017. | This topic last updated: Aug 22, 2017.
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