Changes in Bone Mineral Density and Selected Metabolic Parameters Over 24 Months Following Renal Transplantation

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Abstract

Our aim was to evaluate changes in serum levels of selected bone metabolism indicators and bone density over 24 months following renal transplant. A partial objective was assessment of the effectiveness of prophylactic administration of vitamin D and calcium preparations to prevent progression of osteopathy after kidney transplantation. Forty patients after kidney transplantation were prophylactically given vitamins A and D (800 IU) and calcium (1000 mg) a day. During monitoring, the serum creatinine in all recipients was <200 μmol/L (subgroup A with creatinine concentration < 120 μmol/L versus subgroup B with creatinine 120 to 200 μmol/L). The concentration of serum parathormone, serum level of bone fraction of alkaline phosphatase, serum concentrations of phosphorus and calcium urinary 24-hour excretion of phosphorus and calcium were examined at 2 weeks and 2 years after transplantation. In the same time period, radiographs of thoracic, lumbar spine, and hip joints were obtained. Bone density (BMD) of the lumbar (L) spine and the hip was determined by dual-energy X ray (Lunar Prodigy). Two years after transplantation in subgroup A, the BMD showed decrease in 80% of recipients in the L spine area but hip showed a 15% BMD increase. In subgroup B, the BMD decreased in 95% recipients in L and hip and only 25% showed a BMD increase. No clinical or radiographic sign of fracture was detected in this group. We conclude that prophylactic administration of vitamin D and calcium is not sufficient to prevent the progression of osteopathy after renal transplantation. Changes in bone density evaluated after the kidney transplantation are affected by graft function.

Section snippets

Patients and methods

The cohort included 40 renal transplant recipients (19 women and 21 men of average age 49.5 ± 15.2 years), who all had serum creatinine concentrations below 200 μmol/L subgroub A with creatinine concentrations < 120 μmol/L; subgroup B with creatinine concentrations 120 to 200 μmol/L). All patients were treated with a combination of cyclosporine, mycophenolate mofetil or azathioprine. They were prophylactically given 1000 mg calcium effervescent tablets and 800 IU of vitamins A and D. None of

Results

The results are shown separately for subgroup A of recipients with creatinine concentration less than 120 μmol/L and subgroup B of recipients with creatinine concentration in the range of 120 to 200 μmol/L (Table 1, Table 2, Table 3). Among subgroup A, at 2 years after the renal transplant, the average PTH concentration was 82.92 ± 66.01 pg/mL, while in subgroup B, it was 140.34 ± 150.41 pg/mL (Table 1). Two years after transplantation, the 20 individuals with creatinine concentration < 120

Discussion

Renal osteopathy after a successful kidney transplantation is a frequent complication, characterized by low bone mineral density with increased fracture incidence, osteonecrosis, and bone pain.1 The alterations of bone remodeling after transplantation are heterogeneous; most studies show a decrease in bone formation in the face of persistently elevated bone resorption.2 This imbalance in remodeling favoring resorption leads to a progressive loss of bone mass and to an increased risk of fracture.

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The study was supported by grants IGA MZ CR NK/7741-3 and MSM 151100004.

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