A prospective randomized study for prevention of postrenal transplantation bone loss

El‐Agroudy, Amgad E.; El-Husseini, Amr; El‐Sayed, Moharam; Mohsen, Tarek; Ghoneim, Mohamed A.

doi:10.1111/j.1523-1755.2005.00306.x

Cited by 87 publications

(76 citation statements)

References 26 publications

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“…El-Agroudy et al (66), in another study with 40 male patients who were randomly assigned to ␣-calcidiol plus calcium or placebo, demonstrated that the bone loss that occurred during the first year after renal transplantation could be prevented by ␣-calcidiol. This same group in a recent report randomly assigned 60 adult male patients to placebo, ␣-calcidiol, oral alendronate, or intranasal salmon calcitonin and showed that all treatment groups demonstrated improvement in BMD at all sites, with decreased BMD in the control group (67).…”

Section: Use Of Vitamin D Metabolitesmentioning

confidence: 99%

Bone Disease after Renal Transplantation

Weisinger¹,

Carlini²,

Rojas³

et al. 2006

Clinical Journal of the American Society of Nephrology

125

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It has been well established that a rapid decrease in bone mineral density (BMD) occurs in the first 6 to 12 mo after a successful renal transplantation and persists, albeit at a lower rate, for many years. This rapid BMD loss significantly increases the fracture risk of these patients to levels that are even higher than those of patients who have chronic kidney disease stage 5 and are on dialysis. The presence of low BMD in renal transplant patients as a predictor of risk fracture is controversial. Indeed, as has been suggested also for patients with postmenopausal osteoporosis, there is not a compelling correlation between the decline in BMD and skeletal fractures. However, bone disease after renal transplantation probably represents a unique bone disorder that must encompass underlying renal osteodystrophy. In fact, this syndrome results from multiple factors that include pretransplantation bone status, use of glucocorticoids and other immunosuppressive drugs, hypophosphatemia, and alterations of the calcium-vitamin D axis. Recent studies have demonstrated decreased osteoblast number, reduced bone formation rate, delayed mineralization, and increased osteoblast and osteocyte apoptosis. Bisphosphonates and vitamin D metabolites may be valuable in preventing or diminishing early bone loss. However, clinicians should be careful with the use of bisphosphonates and oversuppression of bone, especially in patients with low bone turnover. New prospective, controlled trials are required to confirm the real efficacy of these drugs, particularly in long-term renal transplant patients.Clin J Am Soc Nephrol 1: 1300 -1313, 2006. doi: 10.2215/CJN.01510506 K idney, heart, lung, and liver transplantation have become fairly common and successful. As the number of transplants has grown, new challenges have arisen in the management of long-term complications of transplantation. Posttransplantation bone disease represents one such important complication, because it is observed in a substantial proportion of patients. As a consequence, bone mass loss and bone fractures are common in these patients and cause substantial morbidity.In patients with chronic kidney disease (CKD), renal osteodystrophy that begins during the early stages of the disease usually worsens during dialysis and may persist after transplantation, although in many patients, improvement in these bone lesions are observed. In addition to preexisting bone lesions, not only factors that hamper recovery but also new factors could affect bone structure after transplantation. These include the potential deleterious effects on bone of the different immunosuppressive agents, the impaired renal function that frequently is observed in renal transplant patients, and several others factors that are particular to each patient, such as postmenopausal status, presence of diabetes, gender, and time after transplantation. Changes in Bone Mineral DensityBone mineral density (BMD) as assessed by dual x-ray absorptiometry has been used as a noninvasive method to assess bone mass loss...

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Section: Use Of Vitamin D Metabolitesmentioning

confidence: 99%

Bone Disease after Renal Transplantation

Weisinger¹,

Carlini²,

Rojas³

et al. 2006

Clinical Journal of the American Society of Nephrology

125

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“…One report noted that intranasal salmon calcitonin 200 IU every other day can prevent early bone loss as effectively as alendronate and alfacalcidol [57] . But other studies failed to demonstrate its superiority to calcium supplementation in transplant recipients [58,59] .…”

Section: Calcitoninmentioning

confidence: 99%

Metabolic bone diseases in kidney transplant recipients

Zhang

Chouhan²

2012

WJN

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Metabolic bone disease after kidney transplantation has a complex pathophysiology and heterogeneous histology. Pre-existing renal osteodystrophy may not resolve completely, but continue or evolve into a different osteodystrophy. Rapid bone loss immediately after transplant can persist, at a lower rate, for years to come. These greatly increase the risk of bone fracture and vertebral collapse. Each patient may have multiple risk factors of bone loss, such as steroids usage, hypogonadism, persistent hyperparathyroidism (HPT), poor allograft function, metabolic acidosis, hypophosphatemia, vitamin D deficiency, aging, immobility and chronic disease. Clinical management requires a comprehensive approach to address the underlying and ongoing disease processes. Successful prevention of bone loss has been shown with vitamin D, bisphosphonates, calcitonin as well as treatment of hypogonadism and HPT. Novel approach to restore the normal bone remodeling and improve the bone quality may be needed in order to effectively decrease bone fracture rate in kidney transplant recipients.

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“…One report noted that intranasal salmon calcitonin 200 IU every other day can prevent early bone loss as effectively as alendronate and alfacalcidol in renal transplant recipients (El-Agroudy et al, 2005). But other studies have failed to demonstrate superiority to calcium supplementation in transplant recipients (Bone et al, 2004;Palmer et al, 2005;.…”

Section: Calcitoninmentioning

confidence: 99%