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Long-term follow-up study on bone mineral density and fractures after simultaneous pancreas-kidney transplantation.

AbstractBACKGROUND:
In type 1 diabetic patients with end-stage renal failure, low bone mass is prevalent and the incidence of fractures high after simultaneous pancreas kidney transplantation (SPK). Data are scarce on preexisting skeletal morbidity or the long-term effects of SPK on bone mass and risk of fractures.
METHODS:
We conducted a prospective study addressing these issues in 19 consecutive SPK recipients before and at 3, 6, and 12 months, and 2.5 to 4 years after establishment of graft function.
RESULTS:
Prior to transplantation, 13 patients (68%) had hyperparathyroidism, 7 of whom had osteoporosis. Mean bone mineral density (BMD) was significantly lower at the femoral neck than at the lumbar spine (T-scores -2.0 +/- 0.89 vs. -0.66 +/- 0.84). There was a significant decrease in BMD at both lumbar spine and femoral neck at 6 months post-transplantation (-6.0 +/- 5.4% and -6.9 +/- 4.3%, respectively). No further loss was observed in the following 6 months. At 1 year post-transplantation, 9 patients had osteoporosis associated with hyperparathyroidism in 8, and none had sustained a clinical fracture. A significant albeit small increase in BMD was observed 6 months after start of alfacalcidol 0.25 microg/day. At end-evaluation, osteoporosis and hyperparathyroidism persisted in the patients in whom it was documented at 1 year. Five patients who had lower BMD at the femoral neck pretransplantation sustained a clinical fracture.
CONCLUSION:
Cortical osteoporosis is prevalent in SPK recipients at the time of transplantation, progresses early post-transplantation, and is associated with relatively high incidence of fractures. Reversal of persistent hyperparathyroidism with the use of alfacalcidol may contribute to a decrease in skeletal morbidity.
AuthorsYves F C Smets, Johan W de Fijter, Jan Ringers, Herman H P J Lemkes, Neveen A T Hamdy
JournalKidney international (Kidney Int) Vol. 66 Issue 5 Pg. 2070-6 (Nov 2004) ISSN: 0085-2538 [Print] United States
PMID15496181 (Publication Type: Journal Article)
Chemical References
  • Hydroxycholecalciferols
  • alfacalcidol
Topics
  • Bone Density (drug effects)
  • Diabetes Mellitus, Type 1 (complications)
  • Diabetic Nephropathies (etiology, metabolism)
  • Follow-Up Studies
  • Fractures, Bone (epidemiology, etiology)
  • Humans
  • Hydroxycholecalciferols (therapeutic use)
  • Hyperparathyroidism (complications, drug therapy)
  • Incidence
  • Kidney Failure, Chronic (complications, etiology, metabolism, surgery)
  • Kidney Transplantation (adverse effects)
  • Osteoporosis (complications)
  • Pancreas Transplantation (adverse effects)
  • Prospective Studies

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