Original Paper

Clinical Reviews in Bone and Mineral Metabolism

, Volume 10, Issue 3, pp 209-218

The Transplant Recipient and Issues in Bone Metabolism

  • Marta ChristovAffiliated withDivision of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School Email author 
  • , Stuart M. SpragueAffiliated withDivision of Nephrology and Hypertension, North Shore University Health System, Evanston Hospital and University of Chicago School of Medicine

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Abstract

Changes in mineral metabolism parameters and the skeleton are commonly seen in kidney transplant recipients, especially in the first 6 months post-transplant. They include correction of complications of end-stage kidney disease, such as hypocalcemia, hyperphosphatemia and secondary hyperparathyroidism—although the latter itself may not resolve fully or may develop de novo with time. Hypercalcemia and hypophosphatemia may occur due to imbalance of their respective regulatory hormones or effects of immunosuppressive medications. Bone formation tends to decrease, and although significant loss of bone mineral density is common, the association of these changes with the significantly increased fracture risk is not well established. Therapeutic approaches have included the use of calcium, vitamin D compounds, bisphosphonates, or calcimimetics which have positively impacted bone mineral density; however, limited data are available in regard to fracture prevention. Thus, studies assessing hard clinical outcomes are urgently needed.

Keywords

Kidney transplant Secondary hyperparathyroidism Renal osteodystrophy