Christian, Rose a; Hansen, Karen E b
Purpose of review: This review highlights recent peer-reviewed literature on the prevalence, etiology, prevention, and treatment of osteoporosis in adult solid organ transplant recipients, who with increased survival now face long-term consequences of transplantation including osteoporosis and fragility fractures.
Recent findings: Many of the factors that contribute to high rates of osteoporosis and fracture, such as immobility, hypogonadism, and vitamin D deficiency, are present in patients awaiting transplant. Identification and treatment of low bone density before transplant may reduce bone loss and fractures after transplant. Both calcitriol and bisphosphonates appear to preserve bone mass in the first posttransplant year, but to date no studies have demonstrated a reduction in fracture risk.
Summary: Low bone mass and fractures are common both before and after solid organ transplantation. Candidates for solid organ transplant would benefit from identification and treatment of low bone mass before transplantation. After transplantation, both calcitriol and alendronate may reduce bone loss, although an effect on incident vertebral fractures has not been demonstrated. Additional clinical trials with a primary endpoint of fracture rate are urgently needed, to confirm that these interventions are indeed beneficial to transplant recipients.
Current Opinion in Orthopedics. 16(5):382-386, October 2005.