Bone disease after renal transplantation

• Published in: Nature reviews. Nephrology Vol. 6; no. 1; pp. 32 - 40
• Main Authors: Malluche, Hartmut H, Monier-Faugere, Marie-Claude, Herberth, Johann
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.01.2010
• Subjects: Animals; Bone diseases; Care and treatment; Chronic Kidney Disease-Mineral and Bone Disorder - epidemiology; Chronic Kidney Disease-Mineral and Bone Disorder - physiopathology; Clinical outcomes; Complications and side effects; Fractures; Histology; Humans; Immunosuppression; Kidney failure; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - surgery; Kidney Transplantation; Kidney transplants; Kidneys; Metabolism; Metabolites; Mineralization; Patients; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Prevention; Prognosis; Risk Factors; Transplantation; Vitamin D; United States
• ISSN: 1759-5061; 1759-507X
• DOI: 10.1038/nrneph.2009.192

In light of greatly improved long-term patient and graft survival after renal transplantation, improving other clinical outcomes such as risk of fracture and cardiovascular disease is of paramount importance. After renal transplantation, a large percentage of patients lose bone. This loss of bone results from a combination of factors that include pre-existing renal osteodystrophy, immunosuppressive therapy, and the effects of chronically reduced renal function after transplantation. In addition to low bone volume, histological abnormalities include decreased bone turnover and defective mineralization. Low bone volume and low bone turnover were recently shown to be associated with cardiovascular calcifications, highlighting specific challenges for medical therapy and the need to prevent low bone turnover in the pretransplant patient. This Review discusses changes in bone histology and mineral metabolism that are associated with renal transplantation and the effects of these changes on clinical outcomes such as fractures and cardiovascular calcifications. Therapeutic modalities are evaluated based on our understanding of bone histology.