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Transplantation Osteoporosis

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Osteoporosis

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

There has been tremendous progress in elucidating the natural history and pathogenesis of transplantation osteoporosis. It is now clear that a substantial proportion of candidates for solid organ and bone marrow transplantation already have osteoporosis. Prospective longitudinal studies have provided definitive evidence of rapid bone loss and a high incidence of fragility fractures, particularly during the first post-transplant year. Vertebral fractures occur both in patients with low and normal pre-transplant BMD, so that it is impossible to predict fracture risk in the individual patient. Early post-transplantation bone loss (before 6 months) is associated with biochemical evidence of uncoupled bone turnover, with increases in markers of resorption and decreases in markers of formation. Later in the post-transplantation course (after 6 months), concomitant with tapering of glucocorticoid doses, bone formation recovers and the biochemical pattern is more typical of a high-turnover osteoporosis. Despite recent studies suggesting that rates of bone loss and fracture are currently lower than they were in prior decades, they remain unacceptably high. Bisphosphonates are the most well-studied and consistently effective agents for the prevention and treatment of bone loss in organ transplant recipients. The skeletal health of patients should be assessed before transplantation and treatment given if osteoporosis is identified. Primary prevention therapy should be initiated immediately after transplantation, as the majority of bone loss occurs in the first few months after grafting. Long-term transplant recipients should be monitored and treated for bone disease as well. With proper vigilance, early diagnosis and treatment, transplant osteoporosis is a preventable disease.

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Authors and Affiliations

  1. Department of Medicine, Lahey Medical Center, Burlington, MA, USA

    Yi Liu

  2. Metabolic Bone Service/Departments of Research and Medicine, Hospital for Special Surgery & Weill Cornell Medical College, New York, NY, USA

    Emily Margaret Stein

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  1. Yi Liu
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  1. Massachusetts General Hospital, Boston, MA, USA

    Benjamin Z. Leder

  2. Massachusetts General Hospital, Boston, MA, USA

    Marc N. Wein

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Liu, Y., Stein, E.M. (2020). Transplantation Osteoporosis. In: Leder, B., Wein, M. (eds) Osteoporosis. Contemporary Endocrinology. Humana, Cham. https://doi.org/10.1007/978-3-319-69287-6_22

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