Decreased Bone Mineral Density in Patients Submitted to Kidney Transplantation Is Related to Age, Body Mass Index, Time on Dialysis, and Hyperparathyroidism
Background. Renal transplantation (Tx) influences bone mineral density (BMD) by several mechanisms. The main objective of this study was to correlate BMD and risk factors associated with bone loss in patients submitted to kidney Tx. Methods. We evaluated 88 individuals after renal Tx (median time？=？31.5 months since Tx). All of them sustained glomerular filtration rate ≥60？mL/min/1.73？m2. BMD was measured by dual-energy X-ray absorptiometry (DXA, Prodigy-GE). Calcium, phosphate, albumin, creatinine, and intact parathormone (PTH) were measured at the same time. All statistical tests were two-sided and value less than 0.05 were accepted as significant for all analyses in this study. Results. Serum PTH was raised in 42% patients, but corrected calcium was normal in 83 patients. No fragility fracture was reported, but the overall prevalence of osteoporosis was 27.6% and lower than expected BMD (Z-score ≤ ？2.0 SD) was observed in 28.4%. Patients with lower than expected BMD had higher PTH levels. Conclusions. Older age, lower body mass index (BMI), longer time on dialysis, and elevated PTH levels were identified as the main factors associated with lower BMD. 1. Introduction Chronic kidney disease is caused by several conditions and has become a prevalent comorbidity. Renal transplantation (Tx) is the treatment of choice for most patients with end-stage renal disease (ESRD) [1]. Advances in immunosuppressive agents and transplant techniques during the last decades have led to improved long-term graft and patient survival. This fact resulted in both increases in transplant numbers and an increased recognition of previously neglected long-term complications of Tx, such as osteoporosis and fractures. Osteoporosis is prevalent in more than half of solid organ recipients and vertebral fractures are found in almost a third of patients [2]. Particularly during the early post-Tx period, kidney recipients experience a rapid loss of bone mass [3]. Rates of bone loss are greatest during the first 6–18 months after renal Tx and range from 4 to 9% at the spine and 5 to 8% at the hip [4]. Different factors have been associated to this bone disease. Chronic kidney disease-mineral and bone disorder (CKD-MBD) begins during the early stages of the disease and usually worsens during dialysis. Both pretransplantation bone disease and immunosuppressive therapy result in rapid bone loss and increased fracture rates [4, 5]. It is expected that parathormone (PTH) levels reach 50% of their initial values on the fourteenth day after renal Tx and that hyperparathyroidism (HPT) reverses
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