Post-Tx Fractures Underrecognized?
Fracture rate among solid organ transplant recipients is up to 15 times that of the normal population.
That means, more aggressive ap-proaches may prevent bone loss and subsequent fractures, said Stuart Sprague, DO, professor of medicine at the Northwestern University Feinberg School of Medicine in
He presented data on approximately 600 patients who underwent solid organ transplantation (about 60% renal transplant recipients) and have more than 10 years of follow-up.
“When you correct for age and gender, we found that the fracture rate is about 10-fold to 15-fold greater than is typical in the normal population,” Dr. Sprague said. “These fractures tend to be mostly in distal bones. Patients tend to get fractures rather early after transplantation and then get multiple fractures; that is occurring in about 50% of patients worldwide.”
More than half of the renal transplant recipients with fractures had persistent hyperparathyroidism and about half had hypercalcemia lasting more than three months. About 80% had hypophosphatemia that lasted up to four months. Vitamin D deficiency was a problem in approximately 75% of patients.
“Many of these patients have bone disease before they even have their transplants. So they should be evaluated for bone disease at the time of transplant,” Dr. Sprague advised. “Giving one or two doses of bisphosphonates early on has been shown to cause stabilization of the bone density for up to four years and this was found in all solid organ transplant recipients.”
“Unfortunately, there are not any good studies looking at fracture prevention as an end point following transplantation,” Dr. Sprague said. “The studies have only looked at changes in bone mineral density, and it has been shown that therapy with calcium and calcitriol as well as with bisphosphonates can help improve bone mineral density without any apparent ill effects.”
The literature shows that bisphosphonates can prevent bone loss and reduce fracture risk in glucocorticoids-treated patients without renal disease. Dr. Sprague cautioned that IV bisphosphonates can decrease glomerular filtration rate, especially if infusion rates are too fast.