Analysis of fracture prevalence in kidney-pancreas allograft recipients.

Abstract

Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent diabetes mellitus and renal failure may have additional fracture risks such as low turnover bone disease. This retrospective cohort study was undertaken to determine the long-term incidence and the potential risk factors of posttransplant fractures in patients with insulin-dependent diabetes mellitus undergoing combined kidney-pancreas allograft transplantation. Thirty-five patients with insulin-dependent diabetes mellitus who received a combined kidney-pancreas allograft between 1987 and 1992 were evaluated. Thirty-five kidney allograft recipients matched for age, gender, and the date of transplant were also reviewed. The fracture incidence in the kidney-pancreas group was 49% after transplantation. The rate of first fracture after kidney-pancreas transplantation was 12.1% per patient year, resulting in a 5-yr fracture-free rate of 48%. The initial fracture occurred at a mean of 31.06 +/- 19.9 mo. Steroid exposure was found to increase the risk of fracture, and analysis by means of a Cox regression model estimated that an increase in cumulative steroid exposure of 10 mg/kg at any given month increased the hazard of sustaining a fracture by 9% (95% confidence interval for hazard ratio, 1.01 to 1.18; P = 0.031). This analysis suggests that kidney-pancreas recipients are at significant risk of sustaining a fracture within a few years after transplantation.

Serum phosphorus levels and fracture following renal transplantation

“…Despite this, these findings are consistent with existing studies that have reported elevated rates of peripheral fractures in patients following renal transplantation . Fracture prevalence of 22.5% was reported in a 5‐years follow‐up study and up to 52% in patients with SPK transplant . In these studies, patients with peripheral fractures frequently had coexisting vertebral fractures, and vertebral fractures rates have been reported in up to 60% of long‐term RTRs .…”

“…14,20 Fracture prevalence of 22.5% was reported in a 5-years follow-up study 20 and up to 52% in patients with SPK transplant. 21 In these studies, patients with peripheral fractures frequently had coexisting vertebral fractures, 14 and vertebral fractures rates have been reported in up to 60% of long-term RTRs. three of five patients that had vertebral fractures also had peripheral fractures (ribs, ulna and sternum).…”

Prevalence of low trauma fractures in long-term kidney transplant patients with preserved renal function

“…These data show that KT patients presented significantly higher fracture prevalence than that observed for the general population. Others have found similar fracture rates in KT patients (0-38.5%) (8)(9)(10)(11)(12)(23)(24)(25). Some of this variability in fracture prevalence among KT patients might be related to the design of the study, the population assessed and the criteria used to define fracture, particularly vertebral deformity.…”

“…The most important and disabling clinical outcome of post-transplantation bone disease is fragility fracture (8)(9)(10)(11)(12). KT is associated with early rapid bone loss and subse-quent sustained bone loss, consequently increasing fracture risk (3,4,13).…”

Metabolic acidosis post kidney transplantation

“…Additionally, pre-transplant bone disease may be worsened by the development of post-transplant acidosis and concomitant use of immunosuppressive regimen, especially corticosteroids and CNIs. As a consequence, close to 9% of bone mineral density may be lost at 18 months post-transplant ( Julian et al, 1991 ), therefore increasing the risk of bone fractures in this patient population ( Chiu et al, 1998 ).…”