Management of mineral and bone disorder after kidney transplantation
Current Opinion in Nephrology and Hypertension, 06/01/2012
Kalantar–Zadeh K et al. – Mineral and bone disorder (MBD) following kidney transplantation is common and characterized by loss of bone volume and mineralization abnormalities, often leading to low turnover bone disease. Although there are no well established therapeutic approaches for management of MBD in renal transplant recipients, clinicians should continue individualizing therapy as needed.
- Low turnover bone disease occurs more frequently after kidney transplantation according to bone biopsy studies.
- The risk of fracture is high, especially in the first several months after kidney transplantation.
- Alterations in minerals (calcium, phosphorus and magnesium) and biomarkers of bone metabolism (parathyroid hormone, alkaline phosphatase, vitamin D and FGF–23) are observed with varying impact on posttransplant outcomes.
- Calcineurin inhibitors are linked to osteoporosis, whereas steroid therapy may lead to both osteoporosis and varying degrees of osteonecrosis.
- Sirolimus and everolimus might have a bearing on osteoblast proliferation and differentiation or decreasing osteoclast–mediated bone resorption.
- Selected pharmacologic interventions for the treatment of MBD in transplant patients include steroid withdrawal, and the use of bisphosphonates, vitamin D derivatives, calcimimetics, teriparatide, calcitonin and denosumab.