Skip to main content
Log in

Continuing loss of vertebral mineral density in renal transplant recipients

  • Original Article
  • Published:
European Journal of Nuclear Medicine Aims and scope Submit manuscript

Abstract

This cross-sectional study examined bone abnormalities by digital radiography, bone densitometry and biochemical tests in 44 clinically asymptomatic renal transplant recipients 6–195 months after renal transplantation. Abnormal radiographs were obtained in 40 of the 44 patients. Dual-energy X-ray absorptiometry (DXA) performed at the lumbar spine (L2–L4)/showed a negative Z score in all patients, ranging from −1 to −1.9 in 28 patients and less than −2.0 in 16 patients. The severity of osteopenia increased with the length of time after transplantation and there was a significant correlation with parathyroid hormone values in patients with normal and low glomerular filtration rates. Our data suggest that decreased bone density values (Z score less than −2) are present in about one-third of patients with renal transplants. Bone loss appears to continue after transplantation. Steroid therapy and immunotherapy are probably the cause of this bone loss. Bone mineral measurements alone are helpful in identifying asymptomatic patients with low bone mass after transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Bonomini V, Feletti C, Di Felice A, Buscaroli A. Bone remodelling after renal transplantation. Adv Exp Med Biol 1981;8:207–216.

    Google Scholar 

  2. Gonzales MT, Gonzales C, Grino JM. Long-term evolution of renal osteodystrophy after kidney transplantation: comparative study between intact PTH levels and bone biopsy. Transplant Proc 1990;22:1407–1411.

    Google Scholar 

  3. Kanis JA. Renal bone disease. Nephrology 1985;18:136–143.

    Google Scholar 

  4. Katz JA, Epstein S. Post transplantation bone disease. J Bone Miner Res 1992;7:123–126.

    Google Scholar 

  5. Kwan JT, Almond MK, Evans K, Cunningham J. Changes in total body bone mineral content and regional bone mineral density in renal patients following renal transplantation. Miner Electrolyte Metab 1992;18:166–168.

    Google Scholar 

  6. Julian BA, Laskow DA, Dubovsky J, Dubovsky EV Curtis JJ, Quarles LD. Rapid loss of vertebral mineral density after renal transplantation. N Engl J Med 1991;325:544–550.

    CAS  PubMed  Google Scholar 

  7. Reid IR. Steroid osteoporosis. Calcif Tissue Int 1989; 45:63–67.

    Google Scholar 

  8. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112:352–364.

    Google Scholar 

  9. Mazanec DJ, Grisanti JM. Drug induced osteoporosis. Cleve Clin J Med 1989;56:297–303.

    Google Scholar 

  10. Movsowitz C, Epstein S, Ismail F, Fallon M, Thomas S. Cyclosporine-A in the oophorized rat: unexpected severe bone resorption. J Bone Miner Res 1989;4:393–398.

    Google Scholar 

  11. Stewart PJ, Stern PH. Cyclosporines: correlation of immunosuppressive activity and inhibition of bone resorption. Calcif Tissue Int 1989;45:222–226.

    Google Scholar 

  12. Orcel P, Denne MA, De Vernejoul MC. Cyclosporin A in vitro decreases bone resorption, osteoclast formation and fusion of cells of the monocyte-macrophage lineage. Endocrinology 1991;128:1638–1646.

    Google Scholar 

  13. Orcel P, Bielakoff J, Modrowki D, Miravet L, De Vernejoul MC. Cyclosporin A induces in vivo inhibition of resorption and stimulation of formation in rat bone. J Bone Miner Res 1989;4:387–391.

    Google Scholar 

  14. Stewart PJ, Green OC, Stern PH. Cyclosporine A inhibits calcemic hormone-induced bone resorption in vitro. J Bone Miner Res 1986;1:285–291.

    Google Scholar 

  15. Sungurtekin U, MacDonald AS, Belitsky P, Bitter-Suerman H, Cohen A, Jindal K. Sequential discontinuation of azathioprine and prednisone in renal transplantation. Transplant Proc 1991;23:2226–2227.

    Google Scholar 

  16. Muchmore JS, Cooper DKC, Ye Y, Schlegel VT, Zuhdi N. Loss of vertebral bone density in heart transplant patients. Transplant Proc 1991;23:1184–1185.

    Google Scholar 

  17. 17. Rich GM, Mudge G, LeBoff MS. Cyclosporin A associated osteoporosis in cardiac transplant patients. J Bone Miner Res 1990;5 Suppl 2: abstract 435.

  18. 18. Rivas C, Silverberg SJ, Kim T, Shane E. Osteopenia in cardiac transplant recipients. J Bone Miner Res 1991;6 Suppl 1: abstract 93.

    Google Scholar 

  19. Kelly PJ, Atkinson K, Ward RL, Sambrook PN, Biggs JC, Eisman JA. Reduced bone mineral density in men and women with allogenic bone marrow transplantation. Transplantation 1990;50:881–883.

    Google Scholar 

  20. Seeman E, Wahner HW, Offord KP, Kumar R, Johnson WJ, Riggs BL. Differential effects of endocrine dysfunction on the axial and the appendicular skeleton. J Clin Invest 1982;69:1302–1309.

    Google Scholar 

  21. Feletti C, Docci D, Di Felice A, Bonomini V. Ipofosforemia dopo trapianto renale. In: Bonomini V (ed) Nefrologia, Dialisi Trapianto. Milan: Wichtig;1981:253–256.

    Google Scholar 

  22. Sakhaee K, Brinker K, Helderman JH, et al. Disturbances in mineral metabolism after successful renal transplantation. Miner Electrolyte Metab 1985;11:167–172.

    Google Scholar 

  23. Higgins RM, Richardson AJ, Endre ZH, Frostick SP, Morris PJ. Hypophosphatemia after renal transplantation: relationship to immunosuppressive drug therapy and effects on muscle detected by 31P nuclear magnetic resonance spectroscopy. Nephrol Dial Transplant 1990;5:62–68.

    Google Scholar 

  24. Nehme D, Rondeau E, Paillard F, et al. Aseptic necrosis of bone following renal transplantation: relation with hyperparathyroidism. Nephrol Dial Transplant 1989;4:123–128.

    Google Scholar 

  25. Parfrey PS, Farge D, Parfrey NA, Haneley JA, Guttman RD. The decreased incidence of aseptic necrosis in transplant recipients. A case control study. Transplantation 1986; 41:182–187.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Correspondence to: B. Bagni

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bagni, B., Gilli, P., Cavallini, A. et al. Continuing loss of vertebral mineral density in renal transplant recipients. Eur J Nucl Med 21, 108–112 (1994). https://doi.org/10.1007/BF00175756

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00175756

Key words

Navigation