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Changes in bone mass early after kidney transplantation
Author(s) -
Horber F.F.,
Casez J.P.,
Steiger U.,
Czerniak A.,
Montandon A.,
Jaeger PH
Publication year - 1994
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.5650090102
Subject(s) - osteopenia , medicine , bone mineral , transplantation , femur , osteoporosis , kidney transplantation , urology , kidney , skeleton (computer programming) , bone density , surgery , anatomy
Renal transplant patients exhibit increased rates of trabecular bone fractures, probably due to glucocorticoid‐induced osteopenia, which is known to occur within 6 months after kidney grafting. This mineral loss at a mostly trabecular site (lumbar spine) contrasts with a gain at the radius, which consists mainly of cortical bone. However, the early effects of kidney transplantation on the other parts of the human skeleton and the time course of these changes during the first 5 months after transplantation remain unknown. Therefore, 34 kidney transplant recipients were prospectively followed immediately after kidney grafting (12 ± 1 days, mean ± SEM, and then on a monthly basis up to 152 ± 3 days) and compared with 34 normal healthy volunteers matched for age, sex, and body mass index. Bone mineral measurements of whole body ( n = 34), lumbar spine ( n = 32), and upper femur ( n = 23) were performed using dual‐energy x‐ray absorptiometry (Hologic QDR 1000 W ). At time of transplantation, lumbar bone mineral density (BMD) and BMD of the upper femur were lower ( p < 0.01) in female but not male patients compared with controls. Lumbar BMD decreased by 1.6 ± 0.2% per month in both sexes ( p < 0.01), whereas BMD of upper femur further decreased in males ( p < 0.01) but only tended to decrease in females. At time of transplantation, whole‐body bone area (BA), bone mineral content (BMC), and BMD were decreased by about 8, 15, and 9%, respectively, in patients compared with controls ( p < 0.01). Compartmental analysis revealed similar reductions in BMD and BMC at trunk, head, and limbs, whereas BA was reduced only at limbs ( p < 0.01). During the 152 ± 3 days of observation, BMC and BMD of limbs remained essentially unchanged, whereas BA of limbs increased ( p < 0.01) and BA, BMC, and BMD of trunk and head decreased ( p < 0.01). In conclusion, within 5 months after successful kidney transplantation resulting in good renal function, about 41 g bone mineral is lost, mostly due to losses in the trabecular bone compartment (i.e., about 10%). Longitudinal trials to prevent trabecular bone loss during the phase of terminal renal failure and during the first half‐year following transplantation are urgently needed to develop rational and effective therapeutic strategies in patients on dialysis and kidney transplant patients.