Bone disease after renal transplantation
- Thomas Nickolas, MD, MS
Thomas Nickolas, MD, MS
- Associate Professor of Medicine
- Training Program Directory, Nephrology
- Columbia University Medical Center, Department of Medicine, Nephrology
- Sri G Yarlagadda, MD
Sri G Yarlagadda, MD
- Associate Professor
- University of Kansas Medical Center
- L Darryl Quarles, MD
L Darryl Quarles, MD
- Section Editor — Renal Osteodystrophy
- Director, Division of Nephrology
- Associate Dean for Research
- The University of Tennessee Health Science Center
- Kathryn Diemer, MD
Kathryn Diemer, MD
- Associate Professor, Clinical Director, Bone Health Program
- Division of Bone and Mineral Diseases, Washington University School of Medicine
- Elizabeth Shane, MD
Elizabeth Shane, MD
- Professor of Medicine
- Columbia University Medical Center
The major bone diseases that affect renal transplant recipients are osteoporosis and osteonecrosis (avascular necrosis), both of which cause significant long-term morbidity . Osteoporosis increases the risk of fractures [1,2].
Because of their longstanding history of chronic kidney disease (CKD), renal transplant recipients are also vulnerable to persistent hyperparathyroidism and the mineral and bone disorders of chronic kidney disease (CKD-MBD). The evaluation and treatment of osteoporosis are made more complex because of CKD-MBD.
This topic reviews the monitoring, diagnosis, and treatment of osteoporosis and osteonecrosis among renal transplant recipients.
Persistent hyperparathyroidism and other disorders of mineral metabolism are discussed elsewhere. (See "Persistent hyperparathyroidism after renal transplantation".)
Other bone diseases that affect renal transplant patients, including dialysis-related amyloidosis and renal osteodystrophy associated with aluminum toxicity, are far less common and are discussed elsewhere. (See "Dialysis-related amyloidosis", section on 'Overview' and "Aluminum toxicity in chronic kidney disease".)
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- PATHOGENESIS AND RISK FACTORS
- EVALUATION OF OSTEOPOROSIS AND FRACTURE RISK
- Our approach to screening and monitoring renal transplant candidates
- Bone mineral density (BMD) assessment
- Role of bone biopsy
- PREVENTION OF OSTEOPOROSIS
- Our approach to the prevention of osteoporosis
- Lifestyle changes
- Glucocorticoid dose minimization
- Medical therapy
- - Calcium and vitamin D3
- - Active vitamin D analogs
- - Bisphosphonates
- - Denosumab
- - Teriparatide
- TREATMENT OF OSTEOPOROSIS
- Patients with osteoporosis before transplantation
- Patients with osteoporosis after transplantation
- OTHER FORMS OF POSTTRANSPLANT BONE DISEASE
- Bone pain and cyclosporine
- SUMMARY AND RECOMMENDATIONS