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Pediatric solid organ transplantation and osteoporosis: a descriptive study on bone histomorphometric findings

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Abstract

Background

Organ transplantation may lead to secondary osteoporosis in children. This study characterized bone histomorphometric findings in pediatric solid organ transplant recipients who were assessed for suspected secondary osteoporosis.

Methods

Iliac crest biopsies were obtained from 19 children (7.6–18.8 years, 11 male) who had undergone kidney (n = 6), liver (n = 9), or heart (n = 4) transplantation a median 4.6 years (range 0.6–16.3 years) earlier. All patients had received oral glucocorticoids at the time of the biopsy.

Results

Of the 19 patients, 21 % had sustained peripheral fractures and 58 % vertebral compression fractures. Nine children (47 %) had a lumbar spine BMD Z-score below −2.0. Histomorphometric analyses showed low trabecular bone volume (< −1.0 SD) in 6 children (32 %) and decreased trabecular thickness in 14 children (74 %). Seven children (37 %) had high bone turnover at biopsy, and low turnover was found in 6 children (32 %), 1 of whom had adynamic bone disease.

Conclusions

There was a great heterogeneity in the histological findings in different transplant groups, and the results were unpredictable using non-invasive methods. The observed changes in bone quality (i.e. abnormal turnover rate, thin trabeculae) rather than the actual loss of trabecular bone, might explain the increased fracture risk in pediatric solid organ transplant recipients.

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Acknowledgements

The authors would like to acknowledge Ms. Aija Parkkinen and Ms. Ritva Sormunen for their assistance with sample preparation, and financial support from Kuopio University Hospital, the Academy of Finland, National Doctoral Programme of Musculoskeletal Disorders and Biomaterials, the Finnish Cultural Foundation, the Päivikki and Sakari Sohlberg Foundation, the Foundation for Pediatric Research, the Sigrid Juselius Foundation, Emil Aaltonen Foundation, the Folkhälsan Research Foundation, the Helsinki University Hospital research funds, and the strategic funding of the University of Eastern Finland.

Conflict of interest

All authors state that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Bone and Cartilage Research Unit (BCRU), University of Eastern Finland, POB 1627, Mediteknia Building, 70211, Kuopio, Finland

    Inari S. Tamminen & Heikki Kröger

  2. Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland

    Inari S. Tamminen & Hanna Isaksson

  3. Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, POB 100, KYS 70029, Kuopio, Finland

    Inari S. Tamminen & Heikki Kröger

  4. Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, POB 281, 00029 HUS, Helsinki, Finland

    Helena Valta, Hannu Jalanko, Sari Salminen, Mervi K. Mäyränpää & Outi Mäkitie

  5. Department of Orthopaedics and Traumatology, University Hospital of Trondheim, Trondheim, Norway

    Sari Salminen

  6. Division of Solid Mechanics, Department of Orthopedics, Lund University, Box 118, 221 00, Lund, Sweden

    Hanna Isaksson

  7. Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland

    Outi Mäkitie

Authors
  1. Inari S. Tamminen
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  2. Helena Valta
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  3. Hannu Jalanko
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  4. Sari Salminen
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  6. Hanna Isaksson
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  7. Heikki Kröger
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Corresponding author

Correspondence to Inari S. Tamminen.

Additional information

I. S. Tamminen and H. Valta contributed equally to this work.

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Tamminen, I.S., Valta, H., Jalanko, H. et al. Pediatric solid organ transplantation and osteoporosis: a descriptive study on bone histomorphometric findings. Pediatr Nephrol 29, 1431–1440 (2014). https://doi.org/10.1007/s00467-014-2771-1

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  • DOI: https://doi.org/10.1007/s00467-014-2771-1

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