, Volume 10, Issue 3, pp 209-218
Date: 01 Nov 2011

The Transplant Recipient and Issues in Bone Metabolism

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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.